Key result
PE diagnosis is linked to ~3.2-fold higher odds of indefinite anticoagulation versus DVT alone.
Why the study?
Consensus guidelines recommend similar anticoagulation algorithms for PE and DVT despite considerable differences between the two VTE manifestations. Real-world data on contemporary management strategies in PE versus DVT alone were needed to help tailor future recommendations toward more individualized patient care.
Does a diagnosis of pulmonary embolism compared to deep vein thrombosis alone increase the prescription of indefinite-duration anticoagulation and 90-day clinical outcomes in patients with confirmed venous thromboembolism?
Cohort (n=2,062)
Yes
Does a diagnosis of pulmonary embolism compared to deep vein thrombosis alone increase the prescription of indefinite-duration anticoagulation and 90-day clinical outcomes in patients with confirmed venous thromboembolism?
In routine clinical practice in Switzerland, clinicians prescribe indefinite anticoagulation more than twice as frequently for pulmonary embolism than for deep vein thrombosis alone across all clinical subgroups, diverging from current guideline algorithms that recommend similar duration strategies for both VTE manifestations.
Answers are grounded in this paper and cite their sources.
PE diagnosis was associated with higher indefinite anticoagulation than DVT alone; challenges guidelines recommending similar treatment durations.
BACKGROUND: Although the two manifestations of venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE), vary considerably, the consensus guidelines recommend similar algorithms for therapeutic anticoagulation in both conditions. Real-world data assessing contemporary management strategies in PE and DVT alone may help tailoring future recommendations towards more individualized patient care. METHODS: In the present analysis, we compared demographics, comorbidities, treatment patterns, and clinical outcomes of PE versus DVT only among 2062 consecutive patients with confirmed VTE enrolled by 11 acute care hospitals between November 2012 and February 2015 in the SWIss Venous ThromboEmbolism Registry (SWIVTER). RESULTS: Overall, 1246 (60 %) patients were diagnosed with PE. In comparison to DVT alone, PE patients were older (66 vs. 59 years; p < 0.001), more frequently had acute and chronic comorbidities, less frequently had prior VTE and hormone replacement, and were less often pregnant. VTE was considered similarly often provoked in patients with PE and DVT alone (33.8 % vs. 33.5 %; p = 0.88). Anticoagulation for an indefinite duration was more often prescribed to patients with PE than those with DVT alone (45.7 vs. 19.6 %; p < 0.001), and PE diagnosis was the strongest independent predictor of indefinite anticoagulation (OR 3.21; 95 % CI 2.55-4.06; p < 0.001). Diagnosis of PE was associated with both increased risk of 90-day mortality (HR 2.31, 95 % CI 1.44-3.71; p = 0.001) and major bleeding (HR 3.88, 95 % CI 1.63-9.22; p = 0.002). CONCLUSIONS: Our analysis affirms differences in demographics, risk factors, and clinical outcomes of PE versus DVT alone. In routine clinical practice, duration of anticoagulation is being managed differently between the two manifestations of VTE, in contrast to recommendations of the current consensus guidelines.
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Wenger et al. (2022) conducted a cohort in Venous thromboembolism (pulmonary embolism and deep vein thrombosis) (n=2,062). Pulmonary embolism (with or without deep vein thrombosis) vs. Deep vein thrombosis alone was evaluated on Prescription of anticoagulation for an indefinite duration (OR 3.21, 95% CI 2.55-4.06, p=<0.001). Pulmonary embolism diagnosis was associated with a higher rate of indefinite anticoagulation prescription compared to deep vein thrombosis alone (45.7% vs. 19.6%; OR 3.21, 95% CI 2.55-4.06; p<0.001).
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