Knowledge, Attitude, and Practice Toward Long-Term Anticoagulation in Patients with Venous Thromboembolism: A Cross-Sectional Study

Background: This study aimed to explore the knowledge, attitude, and practice related to long-term anticoagulation therapy among patients with venous thromboembolism (VTE). Methods: A cross-sectional study using a convenience sampling approach was conducted at the Interventional Vascular Surgery Center of Affiliated Hospital of Shandong Second Medical University from July 2025 to October 2025. A self-developed questionnaire based on the KAP framework was used for data collection, comprising three dimensions: knowledge (12 items), attitude (7 items), and practice (12 items, of which 5 scored items were used to calculate the practice domain score). Age-stratified subgroup analyses were conducted, and structural equation modeling was performed using AMOS 26.0 with bias-corrected bootstrap resampling to assess direct and indirect effects. Results: A total of 389 patients with VTE were included, with a mean age of 45.62 years. Male patients accounted for 55.53% of the respondents. The mean scores were 40.87 ± 10.35 (possible range: 12– 60) for knowledge, 24.61 ± 5.32 (possible range: 7– 35) for attitudes, and 19.41 ± 4.15 (possible range: 5– 25) for practices. Based on the predefined 70% threshold, 206 patients (52.96%) met the criterion for adequate knowledge, whereas 183 (47.04%) were below this threshold. In addition, 231 (59.38%) had a positive attitude and 295 (75.84%) had proactive practice. Age-stratified analysis showed significant differences in knowledge, attitude, and practice scores across age groups (P < 0.001, P < 0.001, and P = 0.047, respectively), with patients aged < 45 years showing higher knowledge and attitude scores than older groups. Correlation analysis showed that knowledge was positively correlated with attitude (r = 0.597, P < 0.001), knowledge was positively correlated with practice (r = 0.364, P < 0.001), and attitude was positively correlated with practice (r = 0.487, P < 0.001). Structural equation modeling (SEM) results showed that attitude had a direct effect on practice (β = 0.674, 95% CI: 0.327– 1.068, P = 0.018), while knowledge indirectly affected practice through attitude (β = 0.473, 95% CI: 0.185– 0.783, P = 0.025). Conclusion: Patients with VTE showed suboptimal knowledge, positive attitudes, and proactive practices towards long-term anticoagulation therapy. To enhance treatment adherence and safety, future clinical strategies should prioritize structured, attitude-oriented educational interventions that not only convey essential knowledge but also address patient concerns and behavioral barriers through individualized, longitudinal support mechanisms. Keywords: venous thromboembolism, anticoagulants, medication adherence, patient knowledge, health behavior, cross-sectional studies