Our study’s possibly eligible group, whose members each had one relative contraindication to outpatient therapy, had no in-hospital complications. When developing the a priori criteria, we decided to keep the possibly eligible group separate from the eligible group based on a lack of data related to potential outpatient and LMWH therapy in patients with certain characteristics. For example, there have been limited data published regarding use of LMWH in pregnant patients. Also, dialysis therapy is considered a relative contraindication because LMWH is cleared primarily via the kidneys, and appropriate dosing may be difficult. In addition, there is an increased risk of hemorrhage in patients with renal failure. The geographic criterion was developed because of potential difficulties with follow-up in remote areas. As LMWH use and outpatient treatment of DVTs becomes more routine in the medical community, these contraindications should be reevaluated.
Age > 75 years, seen in almost half of our study cohort, was created as an exclusion criteria based on studies suggesting an increased incidence of hemorrhage in elderly patients receiving anticoag-ulation. In addition, elderly patients have an increased incidence of venous thromboembolism and death. Our results confirmed a higher risk of adverse events in the elderly compared with the younger patients, including death, major bleeding, and recurrent venous thromboembolism. inhalers for asthma
The determination of complication rates was based on a retrospective analysis of events during inpatient hospitalization for initial DVT therapy. Retrospective data collection has inherent biases and potential limitations. First, lack of documentation or confirmatory tests by the patients’ health-care providers may have limited our ability to determine accurate complication rates. However, the study’s outcomes (complications) were clearly defined and objective. Second, complications after hospital discharge were not determined. However, complications occurring after the completion of heparin administration have little relevance to the choice of the initial treatment setting.