Long-Term Anticoagulant Therapy of Patients with Venous Thromboembolism. What Are the Practices?
Por:
Mahé I, Sterpu R, Bertoletti L, López-Jiménez L, Mellado Joan M, Trujillo-Santos J, Ballaz A, Hernández Blasco LM, Marchena P, Monreal M and RIETE Investigators
Publicada:
15 jun 2015
Ahead of Print:
15 jun 2015
Resumen:
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.
Filiaciones:
Mahé I:
Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, EA REMES 7334, Université Paris Diderot, Sorbonne Paris Cité, France
Sterpu R:
Department of Internal Medicine, Hôpital Louis Mourier, Colombes, (APHP), University Paris 7, Paris, France
Bertoletti L:
Department of Vascular and Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France
López-Jiménez L:
Department of Internal Medicine, Hospital Provincial Reina Sofía, Córdoba, Spain
Mellado Joan M:
Department of Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain
Trujillo-Santos J:
Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain
Ballaz A:
Department of Pneumonology, Hospital de Galdakao, Vizcaya, Spain
Hernández Blasco LM:
Department of Pneumonology, Hospital General Universitario de Alicante, Alicante, Spain
Marchena P:
Department of Internal Medicine, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain
Monreal M:
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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