New Anticoagulant Treats Blood Clots at Home, Greatly Reducing Length of Stay

Patients with blood clots in their legs can now self-inject a new anticoagulant medicine and so receive most of their treatment at home rather than in the hospital.

Inpatient care usually means a hospital length of stay (LOS) of from five to seven days. Now, the LOS is reduced to only one or two days, says Geno J. Merli, MD, The Ludwig A. Kind Clinical Professor of Medicine, Vice Chairman for Primary Care, and Director, Division of Internal Medicine, Department of Medicine, Jefferson Medical College (JMC).

A service offering the new treatment began at Thomas Jefferson University Hospital following the January 1999 approval by the Federal Drug Administration (FDA) of enoxaparin, a new form of heparin, an anticoagulant medicine used for years to treat blood clots intravenously in inpatient settings. 

Enoxaparin is one of a group of “low molecular weight” heparins (LMWHs) found to be safer and more effective than standard heparin, Dr. Merli explains. Successful findings from extensive clinical trials beginning in the late 1980s made it “obvious” that LMWHs could be self-injected and thus used in outpatient care, he says. A number of the clinical trials were performed at Jefferson University Hospital.

The FDA approval of enoxaparin triggered the creation at Jefferson University Hospital of the Anti-Thrombotic Therapy Service (JATS), available to physicians 24 hours a day, seven days a week, to help patients with anticoagulation-related problems, particularly those involving clots in the leg, or deep-vein thrombosis (DVT). JATS, a team from Internal Medicine, Family Medicine, Home Infusion Service, Nursing Service, Home Health Care and Pharmacy, developed a home care and education protocol for patients receiving the new treatment, whose benefits include:

• Reducing LOS

• Freeing inpatient beds for other admissions

• Reducing costs

Program To Be Launched at The Jefferson Health System Member Hospitals

Dr. Merli estimates lower leg blood clots account for 300 admissions yearly at Jefferson University Hospital.

Plans are to launch the program at other member hospitals of the Jefferson Health System (JHS) where it is anticipated to affect an additional 1,200 admissions yearly. “With a dramatically reduced LOS for every admission, we should see a very significant cost saving system-wide,” says Stanton N. Smullens, MD, Chief Medical Officer, JHS.

“While the patient population for DVT is large and diverse, patients with cancer are the biggest group we treat because they have a higher risk for developing blood clots. Other large patient groups are post surgical, trauma, and those who have been immobilized for long periods of time, say for several weeks in a leg cast,” Dr. Merli says. 

Stressing how much a team effort was involved in the evolution of JATS, Dr. Merli says, “The hospital identified a problem and supported our interdisciplinary effort financially so it has now grown and developed to impact such important issues as LOS, bed utilization and cost savings.” 

He credits David B. Nash, MD, MBA, Associate Dean, JMC, and Director, Office of Health Policy and Clinical Outcomes, Jefferson University Hospital, with identifying early on the program’s potential to impact LOS.

To deliver the new service, Dr. Merli’s team created a system of care enabling physicians to call 215-955-6540 where Dr. Merli or other team members such as Susan Lynch, RN, CACP, nurse coordinator, or pharmacists Lynn Thompson, PharmD, and William O’Hara, PharmD, evaluate each patient for home treatment. Then the hospital’s Home Infusion and Home Health Care services become involved. 

“We believe this program is a revolutionary approach bringing benefits in many areas,” Dr. Merli concludes. “We welcome the opportunity to explore its potential benefits with other care disciplines.” 

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