© 2005 European Society for Medical Oncology
Invited Paper |
Home therapy for deep vein thrombosis and pulmonary embolism in cancer patients
1 U.O. di Ematologia con Trapianto, Azienda Ospedaliera Universitaria ‘P. Giaccone’, Palermo; 2 U.O. di Oncologia, Azienda Ospedaliera Universitaria ‘P. Giaccone’, Palermo; 3 U.O. di Chirurgia Vacolare Azienda Ospedaliera Universitaria ‘P. Giaccone’, Palermo, Italy
*Correspondence to: Dr Sergio Siragusa, U.O. di Ematologia con Trapianto, Azienda Ospedaliera Universitaria ‘P. Giaccone’, Palermo, Via del Vespro 127, 90127 Palermo, Italy. Tel/Fax: +39-091-6554574; Email: sergio.siragusa{at}unipa.it
Outpatient treatment of deep vein thrombosis (DVT) has become a common practice in uncomplicated patients. Few data are still present in patients with comorbidity (such as cancer) or concomitant symptomatic pulmonary embolism. Cancer patients with DVT are often excluded from home treatment because they have a higher risk of both bleeding and recurrent DVT. We tested the feasibility and safety of the Home Treatment (HT) program for acute DVT a PE in cancer patients. Patients were treated as outpatients unless they required admission for other medical problems, were actively bleeding or had pain that requires parenteral narcotics. Outpatient treatment was with low molecular weight heparin (LMWH) followed by warfarin or with LMWH alone. An educational program for patients was implemented. Two-hundred and seven patients with cancer were evaluated, 36 (17.4%) of whom had metastatic disease. Treatment with LMWH and warfarin was prescribed to 106 (51.2%) and LMWH alone to 102 (48.8%). One hundred and twenty-seven patients (61.3%) were entirely treated at home. There were no differences between patients treated at home and hospitalized patients with regard to gender, mean age, site of cancer, presence of metastases, and treatment. After 6 months, recurrent thrombo-embolism occurred in 8.7% of patients treated at home and in 5.6% of hospitalized patients (P=0.58); major bleeding in 2.0% and 1.5%, respectively (P=0.06). Twenty-seven patients (33%) in the hospitalized, and 33 (26%) in the home-treatment group, died after a follow-up of 6 months. These results indicate that, regarding cancer patients with acute DVT and/or PE, there is no difference between hospitalised and home-treated patients in terms of major outcomes.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  V. F. Tapson and M. V. Huisman Home at last? Early discharge for acute pulmonary embolism Eur. Respir. J., October 1, 2007; 30(4): 613 - 615. [Full Text] [PDF]
|
|