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Lower risk blood clot treatment ‘empowers’ patients

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Treating patients admitted with blood clots with a drug that allows them to go home on the same day is more effective that being given an injectable anticoagulant, according to US researchers.

Researchers at the Indiana University School of Medicine treated 106 low-risk patients diagnosed with deep vein thrombosis or pulmonary embolism on two accident and emergency departments.

“This treatment for DVT or pulmonary embolisms takes a condition that is life-threatening and makes it something the patient can control”

Jeffrey Kline

The patients were admitted to A&E over 12 months, with 71 having deep vein thrombosis, 30 had pulmonary embolisms and five had both diagnoses.

The patients in the study were treated with rivaroxaban, which does not require daily blood monitoring, and released to go home – compared with heparin, an injectable anticoagulant, and oral warfarin with close monitoring.

The drug already has the backing of the National Institute for Health and Clinical Excellence for a range of clot prevention scenarios.

In the US trial, he patients received follow up monitoring at two and five weeks, and at three and six months – as opposed to almost every week for heparin and warfarin.

Senior author Dr Jeffrey Kline said the prospect of being able to send patients home from A&E was a quality of life issue.

In addition to avoiding a hospital stay, the researchers found that patients diagnosed with DVT, who were immediately discharged and treated with rivaroxaban, had a low rate of recurrent thrombosis and bleeding.

“This study is about giving patients a new option,” said Dr Kline. “Treating patients at home for blood clots was found to have fewer errors than the standard of care and better outcomes.

“Patients have to be taught to give themselves injections and it scares them to death,” he said. “Almost everyone has taken a pill so there is no learning curve for patients.”

In a second study, the researchers compared costs associated with both treatment protocols and found that the rivaroxaban protocol resulted in about half the cost of hospitalisation and treatment with heparin and warfarin.

Dr Kline added: “This treatment for DVT or pulmonary embolisms takes a condition that is life-threatening and makes it something the patient can control.”

The studies have both been published in the Academic Emergency Medicine.

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