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.
Highlights
For many years, the American College of Chest Physicians (ACCP) recommend that patients with acute venous thromboembolism (VTE) to be treated initially with parenteral anticoagulation (Grade 1B) [1]
In patients with active cancer, concordant clinical trials lead to a specific recommendation in favour of low-molecular weight heparin (LMWH) over vitamin K antagonists (VKA) therapy since 2004 (Grade 2B) [1]
The RIETE (Registro Informatizado de Enfermedad TromboEmbólica) Registry is an ongoing, multicenter, international (Spain, Italy, France, Israel, Greece, Switzerland, Czech Republic and Macedonia), observational registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. It started in Spain in 2001, and 6 years later the database was translated into English with the aim to expand the Registry to other countries, allowing physicians worldwide to use the database to select the most appropriate therapy for their patients
Summary
The American College of Chest Physicians (ACCP) recommend that patients with acute venous thromboembolism (VTE) to be treated initially with parenteral anticoagulation (low-molecular-weight heparin [LMWH], fondaparinux or unfractionated heparin [UFH]) (Grade 1B) [1]. The implementation of recommendations on practices is the only relevant feature but little is known about patterns of management of VTE in real life, after hospital discharge Such information could possibly contribute to identify remediable gaps in patient care. The RIETE (Registro Informatizado de Enfermedad TromboEmbólica) Registry is an ongoing, multicenter, international (Spain, Italy, France, Israel, Greece, Switzerland, Czech Republic and Macedonia), observational registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. It started in Spain in 2001, and 6 years later the database was translated into English with the aim to expand the Registry to other countries, allowing physicians worldwide to use the database to select the most appropriate therapy for their patients. We evaluated anticoagulant practices for VTE treatment over more than 10 years, and tried to identify determinants and patient-related factors for VTE management, according to international guidelines
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
