title: Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares: A clinical practice survey.
abstract: BACKGROUND
  Distal deep-vein thromboses (iDDVT) are infra-popliteal DVTs. They are as frequent but less serious than proximal DVT. Their management is debated.
  
  
  METHODS
  Clinical practice survey among a random selection of 111 general practitioners (GP) and 56 vascular medicine physicians (VMP) working in Languedoc-Roussillon (France) to assess and compare iDDVTs management by GP and VMP.
  
  
  RESULTS
  In case of DVT, GP manage their patients alone in 35% of cases. In case of collaborative management, VMP initiate and stop anticoagulants (>74% of cases) whereas GP monitor anticoagulation (>76% of cases). With iDDVT, there was no difference between GP and VMP in terms of use (94% vs. 92%) and intensity of anticoagulation (full dose: 99%vs.100%). Duration of anticoagulation differed: GP modulated less frequently duration of anticoagulation in presence of a transient risk factor (58% vs. 90%, p<0.05) or according to the deep-calf or muscular location of iDDVT (6% vs. 36%, p<0.05) and treated more frequently iDDVT as long as proximal DVT (49% vs. 13%, p<0.05). When comparing GP, there was no significant difference in terms of therapeutic management between those who used to manage DVT alone and those who used to manage in collaboration with a thrombosis expert.
  
  
  CONCLUSIONS
  Treatment of iDDVT differed between GP and VMP. Half of GP don't modulate treatment according to anatomical location or to the provoked/unprovoked character of DVT. Given the low frequency of exposure to DVT in general practice, systematic referral to a thrombosis expert rather than continuous medical formation program seems appropriate to improve management.
authors.affiliation: Clinical Investigation Centre and Department of Internal Medicine, Montpellier University Hospital, Montpellier, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Almosni
authors.affiliation: Department of Biostatistics, Montpellier University Hospital, Montpellier, France.
authors.forename: Arthur
authors.initials: A
authors.lastname: Meusy
authors.affiliation: General Practitioner, Banyuls sur Mer, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Frances
authors.affiliation: Clinical Investigation Centre and Department of Internal Medicine, Montpellier University Hospital, Montpellier, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pontal
authors.affiliation: Clinical Investigation Centre and Department of Internal Medicine, Montpellier University Hospital, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Quéré
authors.affiliation: Clinical Investigation Centre and Department of Internal Medicine, Montpellier University Hospital, Montpellier, France. Electronic address: jp-galanaud@chu-montpellier.fr.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Galanaud
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002309:Cardiology / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D058005:General Practitioners / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D063127:Secondary Health Care / Q000706:statistics & numerical data; D020246:Venous Thrombosis / Q000628:therapy*
chemical_list: D000925:Anticoagulants
keywords: DVT; ambulatory care; anticoagulation; clinical practice survey