The quality of evidence is downgraded by study limitations (lack of blinding), and by indirectness (partial hospital treatment of many in the home treatment arms, and comparison of unfractionated heparin in hospital versus low molecular weight heparins at home).
A Cochrane review [Abstract] 1 included 7 studies with a total of 1 839 subjects. Patients treated at home with low molecular weight heparins (LMWH) were less likely to have recurrence of venous thromboembolism (VTE) compared to hospital treatment with unfractionated heparin (UFH) or LMWH (RR 0.58, 95% CI 0.39 to 0.86; 6 studies, n=1 708). No clear difference was seen between groups for major bleeding (RR 0.67, 95% CI 0.33 to 1.36; 6 studie s, n=1 708), minor bleeding (RR 1.29, 95% CI 0.94 to 1.78; 6 studies, n=1 708), or mortality (RR 0.69, 95% CI 0.44 to 1.09; 6 studies, n=1 708).
Patient satisfaction and quality of life outcomes could not be combined, but 2 of 3 studies found that home treatment led to greater improvement in quality of life compared with in-patient treatment at some point during follow-up, and the third study reported that a large number of participants chose to switch from in-patient care to home-based care for social and personal reasons. None of the studies carried out a full cost-effectiveness analysis. However, a small randomised economic evaluation of the two alternative treatment settings (n=131) found that direct costs were higher for those in the in-patient group. These findings were supported by 3 other studies that reported on their costs.
Primary/Secondary Keywords