Introduction : Outpatient parenteral anticoagulation is not a routine practice in Japan and its experience is limited. We have treated four cases with malignancies successfully in outpatient setting with either unfractionated heparin (UFH) or fondaparinux in patients who failed warfarin or warfarin is not suitable due to frequent need of paracentesis.
Methods : We reviewed four cases which was treated by outpatient parenteral anticoagulation between November 2007 to October 2012.
Cases : Case 1 ; 58 year-old male with pancreatic cancer with DVT/PE was treated with intravenous UFH followed by warfarin. His DVT worsened while he was on warfarin and was switched to subcutaneous (sq) fondaparinux (5mg) with improvement of the DVT. His DVT was successfully managed with outpatient fondaparinux for 23 weeks.
Case 2 : 55 year-old male with lung adenocarcinoma with DVT was initially treated with UFH followed by warfarin with recurrence of DVT. Although sq UFH (20000units twice daily) improved the DVT, hemorrhage occurred when he developed thrombocytopenia due to chemotherapy. Sq fondaparinux (2.5mg) successfully treated the DVT without hemorrhage.
Case 3&4 : 59 year-old female with pancreatic cancer with PE and 68 year-old female with primary peritoneal carcinoma with DVT/PE who needed frequent paracentesis were treated with sq fondaparinux (2.5mg ; 17 weeks) and sq UFH (10000units twice daily ; 6 weeks). They underwent frequent paracetesis without hemorrhage by maintaining the dose on the day of the procedure. The DVT/PE were managed successfully.
Conclusion : Home self-injection parenteral anticoagulation therapy seems safe in Japanese patients and would allow successful outpatient management of VTE. LMWH and fondaparinux may be preferred than sq UFH because of less hemorrhage and require no laboratory monitoring.