Home-treatment of deep vein thrombosis in patients with cancer

Department of Clinical Medicine, University of Insubria, Varese, Italy. walter.ageno@uninsubria.it

BACKGROUND AND OBJECTIVES: Outpatient treatment of deep vein thrombosis (DVT) has become a common practice. However, in some centers cancer patients with DVT are excluded from home treatment because they have a higher risk of both bleeding and recurrent DVT. We performed a retrospective review of clinical practice patterns to assess the rate of cancer patients who were deemed eligible for outpatient treatment of their DVT. DESIGN AND METHODS: The charts of patients from the Thrombosis Units at two tertiary care institutions were reviewed. All patients with objectively documented DVT at our institutions are treated through the Thrombosis Units. Patients are treated as outpatients unless they require admission for other medical problems, are actively bleeding or have pain that requires parenteral narcotics. Outpatient treatment was with low molecular weight heparin (LMWH) followed by warfarin or with LMWH alone. RESULTS: Over a period of almost four years there were 321 patients with cancer, 167 (52.5%) of whom had metastatic disease. The most frequent sites of cancer were genitourinary tract (21.2%), breast (20.5%), and gastrointestinal system (18.4%). Treatment with LMWH and warfarin was prescribed to 67% and LMWH alone to 33%. One hundred and ninety-seven patients (61.4%) 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 3 months, recurrent thromboembolism occurred in 6.1% of patients treated at home and in 4.8% of hospitalized patients (p=0.64), and major bleeding in 1.0% and 4.8%, respectively (p=0.03). One hundred and sixty patients died (49.8%), 100 (50.7%) in the home treatment group and 60 (48.4%) of the hospitalized patients. INTERPRETATION AND CONCLUSIONS: Home treatment of DVT in cancer patients is safe and feasible in almost two-thirds of cases. Outpatient management of antithrombotic treatment did not increase the rate of adverse events, even if the stage of the disease was advanced.

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