Pharmacy-managed program for home treatment of deep vein thrombosis with enoxaparin

A program for home treatment of uncomplicated acute proximal deep vein thrombosis (DVT) with enoxaparin is described. In fall 1995 an HMO in Southern California began developing a pharmacy-managed program in which selected patients with acute proximal DVT receive home treatment with enoxaparin. Adva...

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Bibliographic Details
Published in:	American journal of health-system pharmacy Vol. 54; no. 17; pp. 1968 - 1972
Main Authors:	Dedden, P, Chang, B, Nagel, D
Format:	Journal Article
Language:	English
Published:	Bethesda, MD ASHP 01-09-1997 American Society of Health Pharmacists
Subjects:	Acute Disease Adolescent Adult Aged Aged, 80 and over Anticoagulants - administration & dosage Anticoagulants - therapeutic use Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Enoxaparin - administration & dosage Enoxaparin - therapeutic use Female Health Maintenance Organizations Home Care Services, Hospital-Based Home Infusion Therapy Humans Male Medical sciences Middle Aged Patient Care Team Pharmacology. Drug treatments Thrombophlebitis - drug therapy Thrombophlebitis - economics Warfarin - administration & dosage California United States North America America Human Sanitary program Costs Managed care Chemist Cardiovascular disease Anticoagulant Thrombosis Enoxaparin sodium Venous disease Vascular disease Chemotherapy Treatment Health economy At home Deep vein Public health
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Summary:	A program for home treatment of uncomplicated acute proximal deep vein thrombosis (DVT) with enoxaparin is described. In fall 1995 an HMO in Southern California began developing a pharmacy-managed program in which selected patients with acute proximal DVT receive home treatment with enoxaparin. Advantages of the program included expected cost avoidance. The safety and efficacy of such therapy were verified, and quality control measures were established. Patients are referred to the program by the physicians making the diagnosis of proximal DVT. Upon referral, patients are placed in a holding area. A pharmacist orders laboratory tests and then prescribes warfarin and enoxaparin doses. Patients are given their first doses, taught to safely self-administer enoxaparin, and sent home. Follow-up care, monitoring, and blood sampling are provided through a home health agency. A pharmacist monitors the International Normalized Ratio (INR) and telephones the patient daily to specify the day's warfarin dose. Patients receive concurrent enoxaparin and warfarin therapy for at least five days until the INR is > 2; enoxaparin is then discontinued and patients are transferred to an outpatient anticoagulation service for continued monitoring. From April 1, 1996, to March 27, 1997, 55 patients were treated under the program; all eligible patients were enrolled. A total of 294 hospital days were avoided. There were no complications or hospital admissions due to bleeding. A comprehensive program for home treatment of uncomplicated acute proximal DVT with enoxaparin was implemented at an HMO.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1079-2082 1535-2900
DOI:	10.1093/ajhp/54.17.1968