Long-term anticoagulant therapy of patients with venous thromboembolism. What are the practices?

Mahe, I.; Sterpu, R.; Bertoletti, L.; Lopez-Jimenez, L.; Joan, M. M.; Trujillo-Santos, J.; Ballaz, A.; Hernandez Blasco, L. M.; Marchena, P. J.; Monreal, M.; Ameneiro, E.; Arcelus, J. I.; Ballaz, A.; Barba, R.; Barron, M.; Barron-Andres, B.; Bascunana, J.; Blanco-Molina, A.; Bueso, T.; Casado, I.; Conget, F.; Del Molino, F.; Del Toro, J.; Falga, C.; Fernandez-Capitan, C.; Font, L.; Fuentes, M. I.; Gallego, P.; Garcia-Bragado, F.; Garcia-Lorenzo, M. D.; Gomez, V.; Gonzalez, J.; Gonzalez-Bachs, E.; Guil, M.; Gutierrez, J.; Hernandez, L.; Hernandez-Huerta, S.; Jaras, M. J.; Jimenez, D.; Lecumberri, R.; Lobo, J. L.; Lopez-Jimenez, L.; Lopez-Montes, L.; Lopez-Reyes, R.; Lopez-Saez, J. B.; Lorente, M. A.; Lorenzo, A.; Luque, J. M.; Madridano, O.; Marchena, P. J.; Martin, M.; Mellado, M.; Monreal, M.; Mora, J. M.; Nauffal, D.; Nieto, J. A.; Nunez, M. J.; Ogea, J. L.; Paul, H.; Pedrajas, J. M.; Peris, M. L.; Porras, J. A.; Riera-Mestre, A.; Rivas, A.; Rodriguez-Davila, M. A.; Roman, P.; Rosa, V.; Ruiz-Gimenez, N.; Ruiz, J.; Sahuquillo, J. C.; Samperiz, A.; Sanchez, R.; Sanchez Munoz-Torrero, J. F.; Soler, S.; Surinach, J. M.; Tiberio, G.; Tilvan, R. M.; Tolosa, C.; Trujillo-Santos, J.; Uresandi, F.; Valdes, M.; Valero, B.; Valle, R.; Vela, J.; Vidal, G.; Vilella, V.; Villalta, J.; Verhamme, P.; Peerlinck, K.; Wells, P.; Maly, 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.; Dalla Valle, F.; Di Micco, P.; Duce, R.; Guida, A.; Maida, R.; Pasca, S.; Piovella, C.; Prandoni, P.; Rota, L.; Tiraferri, E.; Tonello, D.; Tufano, A.; Visona, A.; Zalunardo, B.; Brinquinho, M.; Miranda, D.; Sousa, M. S.; Bosevski, M.; Kovacevic, D.; Alatri, A.; Bounameaux, H.; Calanca, L.; Mazzolai, L.

doi:10.1371/journal.pone.0128741

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.

Long-term anticoagulant therapy of patients with venous thromboembolism. What are the practices? / Mahe, I.; Sterpu, R.; Bertoletti, L.; Lopez-Jimenez, L.; Joan, M. M.; Trujillo-Santos, J.; Ballaz, A.; Hernandez Blasco, L. M.; Marchena, P. J.; Monreal, M.; Ameneiro, E.; Arcelus, J. I.; Ballaz, A.; Barba, R.; Barron, M.; Barron-Andres, B.; Bascunana, J.; Blanco-Molina, A.; Bueso, T.; Casado, I.; Conget, F.; Del Molino, F.; Del Toro, J.; Falga, C.; Fernandez-Capitan, C.; Font, L.; Fuentes, M. I.; Gallego, P.; Garcia-Bragado, F.; Garcia-Lorenzo, M. D.; Gomez, V.; Gonzalez, J.; Gonzalez-Bachs, E.; Guil, M.; Gutierrez, J.; Hernandez, L.; Hernandez-Huerta, S.; Jaras, M. J.; Jimenez, D.; Lecumberri, R.; Lobo, J. L.; Lopez-Jimenez, L.; Lopez-Montes, L.; Lopez-Reyes, R.; Lopez-Saez, J. B.; Lorente, M. A.; Lorenzo, A.; Luque, J. M.; Madridano, O.; Marchena, P. J.; Martin, M.; Mellado, M.; Monreal, M.; Mora, J. M.; Nauffal, D.; Nieto, J. A.; Nunez, M. J.; Ogea, J. L.; Paul, H.; Pedrajas, J. M.; Peris, M. L.; Porras, J. A.; Riera-Mestre, A.; Rivas, A.; Rodriguez-Davila, M. A.; Roman, P.; Rosa, V.; Ruiz-Gimenez, N.; Ruiz, J.; Sahuquillo, J. C.; Samperiz, A.; Sanchez, R.; Sanchez Munoz-Torrero, J. F.; Soler, S.; Surinach, J. M.; Tiberio, G.; Tilvan, R. M.; Tolosa, C.; Trujillo-Santos, J.; Uresandi, F.; Valdes, M.; Valero, B.; Valle, R.; Vela, J.; Vidal, G.; Vilella, V.; Villalta, J.; Verhamme, P.; Peerlinck, K.; Wells, P.; Maly, 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.; Dalla Valle, F.; Di Micco, P.; Duce, R.; Guida, A.; Maida, R.; Pasca, S.; Piovella, C.; Prandoni, P.; Rota, L.; Tiraferri, E.; Tonello, D.; Tufano, A.; Visona, A.; Zalunardo, B.; Brinquinho, M.; Miranda, D.; Sousa, M. S.; Bosevski, M.; Kovacevic, D.; Alatri, A.; Bounameaux, H.; Calanca, L.; Mazzolai, L.. - In: PLOS ONE. - ISSN 1932-6203. - 10:6(2015). [10.1371/journal.pone.0128741]