title: Long-Term Anticoagulant Therapy of Patients with Venous Thromboembolism. What Are the Practices?
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.
authors.affiliation: Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, EA REMES 7334, Université Paris Diderot, Sorbonne Paris Cité, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mahé
authors.affiliation: Department of Internal Medicine, Hôpital Louis Mourier, Colombes, (APHP), University Paris 7, Paris, France.
authors.forename: Raluca
authors.initials: R
authors.lastname: Sterpu
authors.affiliation: Department of Vascular and Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bertoletti
authors.affiliation: Department of Internal Medicine, Hospital Provincial Reina Sofía, Córdoba, Spain.
authors.forename: Luciano
authors.initials: L
authors.lastname: López-Jiménez
authors.affiliation: Department of Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Mellado Joan
authors.affiliation: Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Department of Pneumonology, Hospital de Galdakao, Vizcaya, Spain.
authors.forename: Aitor
authors.initials: A
authors.lastname: Ballaz
authors.affiliation: Department of Pneumonology, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Luis Manuel
authors.initials: LM
authors.lastname: Hernández Blasco
authors.affiliation: Department of Internal Medicine, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain.
authors.forename: Pablo Javier
authors.initials: PJ
authors.lastname: Marchena
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006495:Heparin, Low-Molecular-Weight; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D013997:Time Factors; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K