Ten studies (n=4,071) that compared in- and out-patient heparin treatment for thromboembolism were included: 4 RCTs and 6 cohort studies (4 retrospective and 2 prospective).
The overall quality of the studies ranged from 38 to 79%. The 4 RCTs scored 64 to 79%.
LMWH (out-patient) versus UFH (in-patient) (8 studies, although not all studies contributed data for all outcomes).
The incidence of recurrent DVT was similar in the out-patient (median 4%, range: 0 to 7) and in-patient groups (median 6%, range: 0 to 9), as was the rate of major bleeding in the out-patient (median 0.5%, range: 0 to 2) and in-patient (1.0%, range: 0 to 2) groups. The mean number of days in hospital was generally lower with LMWH (out-patient; range: 0 to 5.1 days) than with UFH (in-patient; range: 4 to 8.1 days).
LMWH (out-patient) versus LMWH (in-patient) (2 studies).
The rates for all outcomes were approximately similar, although in the one study that reported it, the number of in-patient days was higher with in-patient compared with out-patient LMWH (9.6 versus 1 day).