Long-term anticoagulant therapy of patients with venous thromboembolism. What are the practices?
Mahé, Isabelle (Hôpital Louis Mourier (Colombes, França))
Sterpu, Raluca (Hôpital Louis Mourier (Colombes, França))
Bertoletti, Laurent (Centre Hospitalier Universitaire de Saint-Étienne (França))
López-Jiménez, Luciano (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Mellado Joan, Meritxell (Hospital del Mar (Barcelona, Catalunya))
Trujillo-Santos, Javier (Complejo Hospitalario Universitario de Cartagena)
Ballaz, Aitor (Hospital de Galdakao (Usansolo, Biscaia))
Hernández Blasco, Luis Manuel (Hospital General Universitario de Alicante (Alacant, País Valencià))
Marchena, Pablo Javier (Parc Sanitari Sant Joan de Déu)
Monreal Bosch, Manuel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
RIETE investigators

Date:	2015
Abstract:	Current guidelines of antithrombotic therapy suggest early initiation of vitamin K antagonists (VKA) in non-cancer patients with venous thromboembolism (VTE), and long-term therapy with low-molecular weight heparin (LMWH) for those with cancer. We used data from RIETE (international registry of patients with VTE) to report the use of long-term anticoagulant therapy over time and to identify predictors of anticoagulant choice (regarding international guidelines) in patients with- and without cancer. Among 35,280 patients without cancer, 82% received long-term VKA (but 17% started after the first week). Among 4,378 patients with cancer, 66% received long term LMWH as monotherapy. In patients without cancer, recent bleeding (odds ratio [OR] 2. 70, 95% CI 2. 26-3. 23), age >70 years (OR 1. 15, 95% CI 1. 06-1. 24), immobility (OR 2. 06, 95% CI 1. 93-2. 19), renal insufficiency (OR 2. 42, 95% CI 2. 15-2. 71) and anemia (OR 1. 75, 95% CI 1. 65-1. 87) predicted poor adherence to guidelines. In those with cancer, anemia (OR 1. 83, 95% CI 1. 64-2. 06), immobility (OR 1. 51, 95% CI 1. 30-1. 76) and metastases (OR 3. 22, 95% CI 2. 87-3. 61) predicted long-term LMWH therapy. In conclusion, we report practices of VTE therapy in real life and found that a significant proportion of patients did not receive the recommended treatment. The perceived increased risk for bleeding has an impact on anticoagulant treatment decision.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Venous thromboembolism ; Anticoagulant therapy ; Cancer treatment ; Deep vein thrombosis ; Hemorrhage ; Anemia ; Heparin ; Renal cancer
Published in:	PloS one, Vol. 10, No 6 (June 2015) , p. e0128741, ISSN 1932-6203

DOI: 10.1371/journal.pone.0128741
PMID: 26076483

12 p, 950.8 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles