Deep vein thrombosis (DVT) occurs when a blood clot blocks blood flow through a vein, generally in the legs. This can happen after surgery, trauma, or when a person is immobile. Clots can dislodge and block blood flow to the lungs, which can be fatal. Heparin is a blood-thinning drug used to treat DVT during the first three to five days. Unfractionated heparin is administered intravenously in hospital with laboratory monitoring. New, low molecular weight heparins (LMWH) are given by subcutaneous injection once a day and can be given at home. Oral anticoagulants are then continued for three to six months. After recovery from the acute episode, people may develop post-thrombotic syndrome with leg swelling, varicose veins and ulceration.
The review reports that home treatment with LMWH is more effective in preventing recurrence of venous clotting (thromboembolism) than hospital treatment with heparin or LMWH. Six randomized controlled trials involving 1708 patients with clinically confirmed DVT compared home (LMWH) versus hospital (heparin or LMWH in one trial) treatment. The trials showed that patients treated at home with LMWH had a lower recurrence of venous thromboembolism (RR 0.6, range 0.4 to 0.9) compared with hospital-treated patients. The review also showed trends for home treated patients to be less likely to have major bleeding and fewer deaths but they were more likely to have minor bleeding than people treated in hospital. Limited evidence suggests that home management is cost effective.
Trials had limitations including high exclusion rates and designs that did not take into account short hospital stays for any of the people who were treated at home to allow fair comparison of heparin in hospital with LMWH at home.