Long-term anticoagulant therapy of patients with venous thromboembolism. What are the practices?

Isabelle Mahé, Raluca Sterpu, Laurent Bertoletti, Luciano López-Jiménez, Meritxell Mellado Joan, Javier Trujillo-Santos, Aitor Ballaz, Luis Manuel Hernández Blasco, Pablo Javier Marchena, Manuel Monreal, E. Ameneiro, J. I. Arcelus, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, I. CasadoF. Conget, F. Del Molino, J. Del Toro, C. Falgá, C. Fernández-Capitán, L. Font, M. I. Fuentes, P. Gallego, F. García-Bragado, M. D. García-Lorenzo, V. Gómez, J. González, E. González-Bachs, M. Guil, J. Gutiérrez, L. Hernández, S. Hernández-Huerta, M. J. Jaras, D. Jiménez, R. Lecumberri, J. L. Lobo, L. López-Jiménez, L. López-Montes, R. López-Reyes, J. B. López-Sáez, M. A. Lorente, A. Lorenzo, J. M. Luque, O. Madridano, P. J. Marchena, M. Martín, M. Mellado, M. Monreal, J. M. Mora, D. Nauffal, J. A. Nieto, M. J. Núñez, J. L. Ogea, H. Paul, J. M. Pedrajas, M. L. Peris, J. A. Porras, A. Riera-Mestre, A. Rivas, M. A. Rodríguez-Dávila, P. Román, V. Rosa, N. Ruiz-Giménez, J. Ruiz, J. C. Sahuquillo, A. Samperiz, R. Sánchez, J. F. Sánchez Muñoz-Torrero, S. Soler, J. M. Suriñach, G. Tiberio, R. M. Tilván, C. Tolosa, J. Trujillo-Santos, F. Uresandi, M. Valdés, B. Valero, R. Valle, J. Vela, G. Vidal, V. Vilella, J. Villalta, P. Verhamme, K. Peerlinck, P. Wells, R. Malý, J. Hirmerova, M. Kaletova, L. Bertoletti, A. Bura-Riviere, D. Farge-Bancel, A. Hij, I. Mahe, A. Merah, S. Schellong, D. Babalis, M. Papadakis, I. Tzinieris, A. Braester, B. Brenner, I. Tzoran, D. Zeltser, M. Amitrano, A. Apollonio, G. Barillari, M. Ciammaichella, F. Dalla Valle, P. Di Micco, R. Duce, A. Guida, R. Maida, S. Pasca, C. Piovella, P. Prandoni, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, M. Brinquinho, D. Miranda, M. S. Sousa, M. Bosevski, D. Kovacevic, A. Alatri, H. Bounameaux, L. Calanca, L. Mazzolai

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article numbere0128741
JournalPLoS ONE
Volume10
Issue number6
DOIs
StatePublished - 15 Jun 2015

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