LTP VTE–Long-Term Prevention of Venous ThromboEmbolism: Epidemiology and treatment patterns from a community-based study in western of France

Abstract

Current guidelines recommend extended anticoagulation in patients with unprovoked venous thromboembolism (VTE). However, a precise description of these patients from the “real-world” is lacking. The EPI-GETBO study is a prospective epidemiologic study of VTE in the geographically well-defined Brest district area. All cases of symptomatic VTE between March 2013 and February 2015 were recorded, adjudicated, and included in the study. During the study period, 555 patients with unprovoked symptomatic VTE were included in EPI-GETBO. Patients’ median age was 72.0 years (IQR 57.0;83.0), 45.2% were male, 64.7% had a pulmonary embolism (PE) associated or not with a deep vein thrombosis (DVT) and 29.2% had a previous history of VTE. 5.6% of the patients had atrial fibrillation at the time of VTE diagnosis, 5.9% had a history of coronary artery disease, and 17.3% received antiplatelet medications. A total of 283 (51.0%) patients discontinued anticoagulation during the observation period. In these patients, the median duration of treatment was 183 days (range 0 to 853 days). Patients with PE associated or not with DVT were treated for a longer time than patients with isolated DVT ( P = 0.01). A total of 40 recurrences (14.1%) were observed during follow-up (up to 2 years after initial VTE event) after anticoagulation discontinuation. Based on indirect standardization, we expect an annual 50,054 cases of unprovoked VTE in France, including 32,346 PEs. The 14,1% recurrence rate of VTE after anticoagulation discontinuation confirms the need for extended duration of treatment in this patient population. Attention should be made for the significant number of patients with concomitant arterial disease who may need aspirin if low-dose DOAC is chosen for extended therapy or who may not be eligible for a low-dose DOAC in case of presence of atrial fibrillation.