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Thromb Res. 2015 Apr;135(4):666-72. doi: 10.1016/j.thromres.2015.02.001. Epub 2015 Feb 7.

Duration of anticoagulation after venous thromboembolism in real world clinical practice.

Collaborators (128)

Ameneiro E, Andújar V, Arcelus JI, Arroyo-Cozar M, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Conget F, del Molino F, del Toro J, Falgá C, Fernández-Capitán C, Font L, Fuentes MI, Gallego P, García-Bragado F, García-Lorenzo MD, Gómez V, González J, González-Bachs E, Guil M, Gutiérrez J, Hernández L, Hernández-Huerta D, Jaras MJ, Jiménez D, Lecumberri R, Lobo JL, López-Jiménez L, López-Montes L, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Luque JM, Madridano O, Marchena PJ, Martín M, Mellado M, Monreal M, Nauffal D, Nieto JA, Núñez MJ, Ogea JL, Pedrajas JM, Pérez G, Peris ML, Porras JA, Riera-Mestre A, Rivas A, Rodríguez-Dávila MA, Román P, Roncero A, Rosa V, Ruiz-Giménez N, Ruiz J, Sahuquillo JC, Samperiz A, Sánchez R, Sánchez Muñoz-Torrero JF, Soler S, Suriñach JM, Tiberio G, Tilván RM, Tolosa C, Trujillo-Santos J, Uresandi F, Valdés M, Valero B, Valle R, Vela J, Vidal G, Vilar C, Villalta J, Verhamme P, Peerlinck K, Wells P, Malý R, Hirmerova J, Kaletova M, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahe I, Merah A, Schellong S, Babalis D, Papadakis M, Tzinieris I, Braester A, Brenner B, Tzoran I, Zeltser D, Amitrano M, Apollonio A, Barillari G, Ciammaichella M, Dentali F, Di Micco P, Duce R, Guida A, Maida R, Pasca S, Pesavento R, Piovella C, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Barbosa AL, Bastos M, Sousa MS, Bosevski M, Duskoski D, Kovacevic D, Alatri A, Bounameaux H, Calanca L, Mazzolai L.

Author information

1
Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy. Electronic address: agewal@yahoo.com.
2
Department of Internal Medicine, Hospital Reina Sofía de Tudela, Navarra, Spain.
3
Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
4
Department of Internal Medicine and Emergency Room, Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy.
5
Department of Clinical Medicine, University of Padua, Padua, Italy.
6
Department of Medicine, University of Perugia, Perugia, Italy.
7
Department of Pneumonology, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
8
Department of Cardiovascular Sciences, Vascular Medicine and Haemostasis, University of Leuven, Belgium.
9
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.

Abstract

INTRODUCTION:

Venous thromboembolism (VTE) carries a considerable risk of recurrence and anticoagulants should be administered for a minimum of three months. Since little is known about real life management of VTE, we aimed to describe current practice in the secondary prevention of VTE.

MATERIALS AND METHODS:

Using the database of an international, prospective registry on patients treated for VTE, RIETE, information was collected on risk factors for VTE and bleeding, anticoagulant treatment, and clinical outcomes during follow up. Multivariate analysis using logistic regression was performed to identify predictors of treatment duration.

RESULTS:

Of 6944 patients with a first episode of VTE 41.1% had unprovoked VTE, 31.8% had transient risk factors, 27.1% had cancer. After the exclusion of patients who died during the first year of observation, the rate of patients treated for >12 months was 55.1%, 41.9%, and 43.2%, respectively (p<0.001). Pulmonary embolism at presentation, recurrence while on treatment, chronic heart failure and age >65 years were independently associated with treatment for >12 months. Body weight <75 kg, anemia, cancer, and the presence of transient risk factors were associated with treatment for 12 months or less. Major bleeding occurred more frequently than recurrent VTE in patients with VTE secondary to transient risk factors and cancer; fatal bleeding was more frequent than fatal recurrent PE in all subgroups.

CONCLUSIONS:

We observed heterogeneous duration of anticoagulant treatment for the secondary prevention of VTE. A substantial proportion of patients, in particular those with VTE secondary to transient risk factors, may be exposed to a possibly unnecessary risk of bleeding.

PMID:
25708926
DOI:
10.1016/j.thromres.2015.02.001
[Indexed for MEDLINE]

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