REPLY
Subcutaneous Heparin for Deep Venous Thrombosis
Paolo Prandoni, MD, PhD
15 June 1999 | Volume 130 Issue 12 | Page 1027
IN RESPONSE:
We basically agree with Alatri and colleagues' comments. We did not perform a cost-efficacy analysis. Rather, we simply intended to provide operators with a practical and safe guideline for the initial treatment of deep venous thrombosis with subcutaneous unfractionated heparin. Unfractionated heparin is still the drug of choice and sometimes the only available drug for the treatment of this disease in many countries, including Italy.
We recognize that home treatment of deep venous thrombosis with LMWH is far less expensive than in-hospital treatment with unfractionated heparin (1). However, we believe that early discharge and even home treatment of venous thrombosis might be feasible with the use of subcutaneous unfractionated heparin in doses adjusted to a simple laboratory test. Our view is supported by a recent observation (2). An Italian multicenter study addressing this issue is currently in progress.
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Author and Article Information
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University of Padua Medical School; Padua, Italy (Prandoni)
1. van den Belt AG, Bossuyt PM, Prins MH, Gallus AS, Büller HR. Replacing inpatient care by outpatient care in the treatment of deep venous thrombosis. An economic evaluation. The TASMAN Study Group. Thromb Haemost. 1998;79:259-63.
2. Hirsch DR, Lee TH, Morrison RB, Carlson W, Goldhaber SZ. Shortened hospitalization by means of adjusted-dose subcutaneous heparin for deep venous thrombosis Am Heart J. 1996;131:276-80.[Medline]
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