Regular ArticleDuration of anticoagulation after venous thromboembolism in real world clinical practice
Introduction
Deep vein thrombosis (DVT) and pulmonary embolism (PE) have a considerable long-term risk of recurrence [1], [2]. The major determinant of this risk is the presence of identifiable major provoking factors at the time of the index event [3], [4].
Based on evidence from clinical trials, the American College of Chest Physicians (ACCP) guidelines recommend 3 months of anticoagulant therapy in patients with venous thromboembolism (VTE) secondary to recent surgery or to a nonsurgical transient risk factor, and extended treatment duration in those with active cancer or unprovoked VTE [5]. However, little is known about patterns of management of VTE in real life, particularly after hospital discharge. Such information could identify amendable 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, ultimately allowing physicians worldwide to use the database to select the most appropriate therapy for their patients. Data from this registry have been used to evaluate outcomes after acute VTE, such as the frequency of recurrent VTE, bleeding and mortality, and risk factors for these outcomes. In the current analysis, we evaluated demographic and clinical characteristics of patients with VTE, trying to describe current practice in the secondary prevention of VTE and to identify determinants of duration of anticoagulant therapy.
Section snippets
Study Design
At each participating site, investigators of the RIETE registry enrolled consecutive patients with acute symptomatic VTE confirmed by objective testing including high probability ventilation-perfusion scan or positive spiral computerized tomography for PE, and positive compression ultrasonography for DVT. Treatment decisions were entirely left at the discretion of attending clinicians, and no therapeutic algorithms were provided. Patients enrolled in blinded randomized controlled trials on VTE
Results
A total of 6,944 patients with objectively diagnosed VTE were enrolled in this study. Mean duration of follow-up was 722 days, median 564 days. Baseline characteristics of the study population are reported in Table 1.
Therapeutic strategies are described in Table 2. Median duration of treatment was significantly longer in patients with unprovoked VTE, and the rate of patients who were still on anticoagulant treatment after 12 months was 55.1% in patients with unprovoked VTE, 41.9% in patients with
Discussion
The objective of this study was to obtain clinical practice-based data from the RIETE registry on the management of symptomatic VTE. The results of this large prospective cohort study on nearly 7,000 patients with a first episode of VTE show that in real-world clinical practice, 55% of patients with unprovoked events, 42% of patients with a transient risk factor, and 43% of patients with cancer receive anticoagulant treatment for more than 12 months. The ACCP guidelines recommend a 3-month
Authors’ Contributions
Study concept and design: Ageno, Dentali, Di Micco, Monreal; Acquisition of data: Samperiz, Caballero, Di Micco, Uresandi, Monreal; Analysis and interpretation of data: Ageno, Dentali, Di Micco, Prandoni, Becattini, Verhamme, Monreal; Drafting of the manuscript: Ageno, Dentali, Di Micco, Monreal; Critical revision of the manuscript for important intellectual content: Samperiz, Caballero, Prandoni, Becattini, Uresandi, Verhamme; Final approval of the article: Ageno, Samperiz, Caballero, Dentali,
Conflict of Interest Statement
None to disclose
Financial Disclosure
This Registry is supported by unrestricted educational grants from Sanofi Spain and Bayer Pharma AG.
Acknowledgements
We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 20,07 % of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S & H Medical Science Service, for their quality control data, logistic and administrative support
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A full list of the RIETE investigators is given in the appendix. Written permission has been obtained from all persons named in the acknowledgment.