Key result
After the maintenance period, anticoagulation was extended in 51.3% of patients, switched to antithrombotics in 28.1%, and stopped in 20.6%, regardless of whether the index event was unprovoked or provoked.
Why the study?
Decisions on treatment after a first VTE to prevent recurrences may be influenced by many factors, prompting an analysis of how this is tackled in everyday clinical practice across countries with differing socio-economic and healthcare systems.
Observational (n=1,240)
Yes
In real-world clinical practice across multiple countries, the decision to extend anticoagulation after a first VTE event is driven by factors other than just the provoked or unprovoked nature of the event, with over half of patients receiving extended therapy.
Real-world post-VTE anticoagulation decisions often overlook provoked/unprovoked status; leaves open whether this individualized approach improves outcomes.
The decision on treatment after a first venous thromboembolism (VTE) to prevent recurrences may be influenced by many factors. The prospective, observational, WHITE study aimed to analyze how this issue was tackled in every-day clinical practice in various countries, which have sensibly different socio-economic conditions and healthcare systems. Doctors active in 79 Internal or Vascular clinical centers in 7 countries (China, Czechia, Poland, Portugal, Russia, Slovakia, and Tunisia) enrolled VTE patients after the maintenance treatment phase. The present report analyzed information, collected in the central database, regarding the baseline characteristics, index events, type and duration of anticoagulant therapy and decision on post-maintenance treatment. From April 2018 to December 2020, 1240 patients were enrolled, 58% with an unprovoked index event. Direct oral anticoagulants (DOACs) were used in > 85% of all cases in China, Poland, Portugal, Russia and Czechia, in 52% in Slovakia and in no patient in Tunisia. The maintenance anticoagulation lasted in average approximately 6 months. Altogether, anticoagulation was stopped in 20%, extended in about 50%, regardless of whether the event was unprovoked or provoked and shifted to antithrombotics (mainly sulodexide or aspirin) in the remaining patients. In conclusion, some differences in VTE patient management were found between countries. The provoked/unprovoked nature of the index event, instead, was not the prevalent criterion to drive the decision on extension of anticoagulation, without large variations between countries. DOACs were the most widely used anticoagulant drugs, whereas > 25% of patients received antithrombotic drugs instead of anticoagulants as extended treatment.
No takes yet. Share an insight, caveat, or question.
Palareti et al. (2021) conducted an observational in First-ever event of deep vein thrombosis and/or pulmonary embolism (n=1,240). Clinicians' decisions on secondary prevention management was evaluated on Clinicians' decisions on the modality to manage secondary prevention at the end of the maintenance period. After the maintenance period, anticoagulation was extended in 51.3% of patients, switched to antithrombotics in 28.1%, and stopped in 20.6%, regardless of whether the index event was unprovoked or provoked.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: