Shortened hospitalization by means of adjusted-dose subcutaneous heparin for deep venous thrombosis

Adjusted-dose subcutaneous unfractionated heparin (SC heparin) was used in the initial management of deep venous thrombosis (DVT) to allow shortened hospital stay. Of 78 patients screened, 41% were eligible and 18 (23%) were enrolled. Follow-up venous ultrasound examination was performed 6 weeks after discharge. Of enrolled patients, 16 (89%) completed the protocol. Hospital length of stay was 2 days in protocol patients compared with 5 days for patients receiving conventional inpatient heparin with a continuous intravenous infusion (p = 0.0009). Very high heparin doses (mean 42,000 to 62,000 U daily, given in three divided doses every 8 hours) and a median time of 21 hours were required initially to achieve a target activated partial thromboplastin time (aPTT) >55 seconds. Subsequently many patients had supratherapeutic levels, yet there were no bleeding complications. Four patients (25%) did not show improvement at follow-up ultrasound in spite of aPTTs >55 seconds after the second injection. Clot regression was evident in remaining patients. Hospital cost savings were offset partially by the need for time- and labor-intensive outpatient monitoring after hospital discharge.