Key result
Home treatment for proximal DVT shows similar 90-day clinical outcomes versus in-hospital care.
Why the study?
DOACs have enabled home treatment for symptomatic DVT, but there are few data comparing in-hospital versus home treatment.
Does home treatment compared to in-hospital treatment prevent recurrent PE, major bleeding, and all-cause death in patients with symptomatic proximal DVT without PE?
Does home treatment compared to in-hospital treatment prevent recurrent PE, major bleeding, and all-cause death in patients with symptomatic proximal DVT without PE?
Home treatment for symptomatic proximal DVT without PE appears to be a safe and effective alternative to hospitalization, with similar 90-day rates of recurrent PE, major bleeding, and all-cause death.
May support outpatient proximal DVT care; hypothesis-generating and should not yet change practice.
Background The management of proximal deep vein thrombosis (DVT) has changed significantly with the introduction of direct oral anticoagulants (DOACs), making home treatment possible for patients with symptomatic DVT. However, there are few dates on in-hospital versus home treatment. This study aims to evaluate the clinical outcomes of patients with proximal DVT managed at home treatment versus in-hospital treatment using data from the COMMAND VTE registry-2. Methods The COMMAND VTE Registry-2 is a multicenter registry enrolling consecutive patients with acute symptomatic venous thromboembolism (VTE). This study extracted data from the COMMAND VTE registry-2, selecting 1037 patients diagnosed with proximal DVT without pulmonary embolism (PE). We divided the patients into two groups: those who received home treatement and in-hospital treatment. We evaluated 90-day clinical outcomes comparing home treatement and in-hospital treatement. Clinical outcomes were recurrent PE, major bleeding, and all-cause death. Results Among 1037 patients, there were 450 (44%) in the home treatement group and 587 (56%) in the in-hospital treatment group. The mean age was similar among the two groups (69.1±17.8 vs. 68.5±15.1 years, p=0.62), and the proportion of female was higher in the in-hospital group (63.7% vs 54.9 p<0.01). The use of acute-phase intravenous anticoagulants and IVC filters placement was significantly higher in the in-hospital group. (Intravenous anticoagulants :65.6% vs 8.4% p<0.01/IVC filter :19.3% vs 1.1% p<0.01) At discharge, warfarin was prescribed more frequently in-hospital group than home treatment group (17.2% vs 6.4% p<0.01). The cumulative 90-day incidence of recurrent PE was rare in the two groups, and there was not significantly different among the two group (0.3% vs. 0.5%, log rank p=0.79). There was no significant difference in the cumulative 90-day incidence of major bleeding (3.7% vs. 2.3%, log rank p=0.20) and all-cause death (8.1% vs. 6.9%, log rank p=0.47). In addition, only one PE-related death occurred in the in-hospital treatment group. Conclusion The cumulative 90-day recurrent PE, major bleeding, and all cause death were similar among the two groups. Home treatment for proximal DVT might be a safe and effective alternative to hospitalization.
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Mushiake et al. (2025) studied this question. Home treatment for proximal DVT had similar 90-day rates of recurrent PE (0.3% vs 0.5%), major bleeding (3.7% vs 2.3%), and death (8.1% vs 6.9%) to in-hospital care.
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