Therapeutic approach for patients with venous thromboembolism attended in emergency departments during routine clinical practice: the EDITH study
Abstract
Aim: To analyze treatment at discharge/follow-up of patients diagnosed with venous thromboembolism (VTE) in the emergency department (ED). Materials & methods: Ambispective study (50 Spanish centers) of consecutive patients (October–December 2014) with VTE diagnosed in ED. Results: VTE was diagnosed in 775 patients (295 pulmonary embolism [PE] without deep vein thrombosis [DVT], 389 DVT without PE and 91 PE + DVT); 95.5% received anticoagulants (90.7% low-molecular-weight heparin [LMWH], 4% LMWH + vitamin K antagonists and <1% direct oral anticoagulants). Overall, 23.3% were discharged from ED and 74.5% hospitalized (98.6% with PE and 50.4% with DVT). After discharge/90/180 days, 43.6/21.0/13.5% were taking LMWH, with similar rates in nononcologic patients. Conclusion: There is a poor adherence to international guidelines in management of VTE patients in Spain.
Formats available
You can view the full content in the following formats:
References
Papers of special note have been highlighted as: • of interest
1.
Kearon C, Akl EA, Comerota AJ et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl.), E419S–E496S (2012).
2.
Multidisciplinary group of thromboembolic disease in Spain, Study of thromboembolic disease in Spain. www.fesemi.org/sites/default/files/documentos/publicaciones/estudio-etv.pdf
3.
Cowell RP. Direct oral anticoagulants: integration into clinical practice. Postgrad. Med. J. 90(1067), 529–539 (2014).
• Compared with vitamin K antagonists, optimal implementation of direct oral anticoagulants in the hospital setting will improve patient outcomes.
4.
Aujesky D, Roy PM, Verschuren F et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomized, noninferiority trial. Lancet 378(9785), 41–48 (2011).
• Study highlighting that in selected low-risk patients with pulmonary embolism, outpatient care can be used safely and effectively instead of inpatient care.
5.
Palareti G. Recurrent venous thromboembolism: what is the risk and how to prevent it. Scientifica (Cairo) 2012, 391734 (2012).
• Review of incidence and risk factors for recurrence of venous thromboembolism (VTE), possibility of predicting individual risk of recurrence and recommendations on anticoagulant treatment after a first VTE.
6.
Mahé I, Sterpu R, Bertoletti L et al. Long-term anticoagulant therapy of patients with venous thromboembolism. What are the practices? PLoS ONE 10(6), e0128741 (2015).
• Study based on data from RIETE to identify predictors of anticoagulant choice in patients with and without cancer.
7.
Hull RD, Liang J, Townshend G. Long-term low-molecular-weight heparin and the post-thrombotic syndrome: a systematic review. Am. J. Med. 124(8), 756–765 (2011).
8.
Levine M, Gent M, Hirsh J et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N. Engl. J. Med. 334(11), 677–681 (1996).
9.
Koopman MM, Prandoni P, Piovella F et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. N. Engl. J Med. 334(11), 682–687 (1996).
10.
Zidane M, van Hulsteijn LH, Brenninkmeijer BJ, Huisman MV. Out of hospital treatment with subcutaneous low molecular weight heparin in patients with acute deep-vein thrombosis: a prospective study in daily practice. Haematologica 91(8), 1052–1058 (2006).
11.
Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA 279(6), 458–462 (1998).
12.
Lecumberri R, Alfonso A, Jimenez D et al. Dynamics of case-fatality rates of recurrent thromboembolism and major bleeding in patients treated for venous thromboembolism. Thromb. Haemost. 110(4), 834–843 (2013).
13.
Storm M, Siemsen IM, Laugaland K, Dyrstad DN, Aase K. Quality in transitional care of the elderly: key challenges and relevant improvement measures. Int. J. Integr. Care 14, e013 (2014).
14.
Deitelzweig SB, Lin J, Kreilick C, Hussein M, Battleman D. Warfarin therapy in patients with venous thromboembolism: patterns of use and predictors of clinical outcomes. Adv. Ther. 27(9), 623–633 (2010).
15.
Tagalakis V, Patenaude V, Kahn SR, Suissa S. Treatment patterns of venous thromboembolism in a real-world population: the Q-VTE study cohort. Thromb. Res. 134(4), 795–802 (2014).
16.
Caprini JA, Tapson VF, Hyers TM et al. Treatment of venous thromboembolism: adherence to guidelines and impact of physician knowledge, attitudes and beliefs. J. Vasc. Surg. 42(4), 726–733 (2005).
• Study analzying problems with treatment of VTE and gap between actual practice and clinical guidelines.
17.
Gebler-Hughes ES, Kemp L, Bond MJ. Patients’ perspectives regarding long-term warfarin therapy and the potential transition to new oral anticoagulant therapy. Ther. Adv. Drug Saf. 5(6), 220–228 (2014).
18.
Kneeland PP, Fang MC. Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thromboembolism. Patient Prefer. Adherence 4, 51–60 (2010).
19.
de Jong PG, Coppens M, Middeldorp S. Duration of anticoagulant therapy for venous thromboembolism: balancing benefits and harms on the long term. Br. J. Haematol. 158(4), 433–441 (2012).
20.
Gomez-Outes A, Terleira-Fernandez AI, Lecumberri R, Suarez-Gea ML, Vargas-Castrillon E. Direct oral anticoagulants in the treatment of acute venous thromboembolism: a systematic review and meta-analysis. Thromb. Res. 134(4), 774–782 (2014).
21.
Prins MH, Lensing AW, Bauersachs R et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN–DVT and PE randomized studies. Thromb. J. 11(1), 21 (2013).
• This pooled analysis of the EINSTEIN-deep vein thrombosis and pulmonary embolism randomized studies showed that rivaroxaban in monotherapy had a similar efficacy than the standard-therapy, but with a significantly lower rate of major bleeding.
22.
Nordstrom M, Lindblad B, Bergqvist D, Kjellstrom T. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J. Intern. Med. 232(2), 155–160 (1992).
23.
Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 117(1), 93–102 (2008).
24.
Bai J, Ding X, Du X, Zhao X, Wang Z, Ma Z. Diabetes is associated with increased risk of venous thromboembolism: a systematic review and meta-analysis. Thromb. Res. 135(1), 90–95 (2015).
25.
Ageno W, Mantovani LG, Haas S et al. Safety and effectiveness of oral rivaroxaban versus standard anticoagulation for the treatment of symptomatic deep-vein thrombosis (XALIA): an international, prospective, noninterventional study. Lancet Haematol. 3(1), E12–E21 (2016).
• In this international, prospective and noninterventional study, rivaroxaban was a safe and effective alternative to standard anticoagulation therapy in a broad range of patients with symptomatic deep vein thrombosis.
26.
Nieto JA, De Tuesta AD, Marchena PJ et al. Clinical outcome of patients with venous thromboembolism and recent major bleeding: findings from a prospective registry (RIETE). J. Thromb. Haemos. 3(4), 703–709 (2005).
Information & Authors
Information
Published In
Copyright
© 2018 Future Medicine Ltd.
History
Received: 4 August 2017
Accepted: 31 October 2017
Published online: 23 March 2018
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Therapeutic approach for patients with venous thromboembolism attended in emergency departments during routine clinical practice: the EDITH study. (2018) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2017-0061
Export citation
Select the citation format you wish to export for this article or chapter.