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Pharmacist Specialist, Department of Pharmaceutical Services, University of California (UC) Davis Medical Center, Sacramento, CA; Clinical Professor of Pharmacy, School of Pharmacy, University of California at San Francisco (UCSF); Associate Clinical Professor of Medicine, UC Davis School of Medicine
Coordinator, Clinical Services, Department of Pharmaceutical Services, UC Davis Medical Center; Associate Clinical Professor of Pharmacy, UCSF
Pharmacist Specialist, Department of Pharmaceutical Services, UC Davis Medical Center; Associate Clinical Professor of Pharmacy, School of Pharmacy, UCSF
In community practice
Pharmacy Practice Resident, Long Beach Memorial Medical Center, Long Beach, CA
Pharmacy Practice Resident, Kaiser Permanente Tri Central Pharmacy, Southern California network
Pharmacy Practice Resident, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
Department of Medicine, UC Davis Medical Center; Professor of Clinical Medicine, UC Davis School of Medicine
Reprints: Dr. Dager, Department of Pharmaceutical Services, University of California Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA 95817-2201, fax 916/703-4031, william.dager{at}ucdmc.ucdavis.edu
BACKGROUND: The low-molecular-weight heparins (LMWHs) have been shown to be effective in the outpatient treatment of deep vein thrombosis (DVT). Data regarding outpatient use of any LMWH in pulmonary embolism (PE) or tinzaparin in DVT while transitioning therapy to a vitamin K antagonist are limited.
OBJECTIVE: To determine the safety and efficacy of tinzaparin in patients with either DVT or PE being transitioned to warfarin during LMWH therapy in the outpatient setting.
METHODS: All patients who were treated with at least one outpatient dose of tinzaparin for venous thromboembolism (VTE) were identified. Charts of all patients followed within the University of California Davis healthcare system were reviewed. The incidence of bleeding and recurrent thromboembolism over a minimum of the first 4 weeks to a maximum of 12 weeks after initiating anticoagulation was assessed.
RESULTS: A total of 178 patients with acute VTE were treated with tinzaparin, and outcomes could be determined in 140 cases. Forty-seven percent of these patients had objectively documented PE. Only one (0.7%) case of recurrent VTE was observed. Major bleeding was documented in 5 (3.6%) and minor bleeding in 8 (5.8%) patients. Two bleeding events, both major, occurred during tinzaparin therapy.
CONCLUSIONS: Outpatient use of tinzaparin during transition to warfarin therapy in the treatment of VTE, including PE, appears to be feasible in patients who are judged candidates for home therapy.
Key Words: deep vein thrombosis, low-molecular-weight heparin, outpatient treatment, pulmonary embolism, tinzaparin
Published Online, June 14, 2005. www.theannals.com, DOI 10.1345/aph.1E677
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