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. 2015 Jun 15;10(6):e0128741.
doi: 10.1371/journal.pone.0128741. eCollection 2015.

Long-Term Anticoagulant Therapy of Patients with Venous Thromboembolism. What Are the Practices?

Isabelle Mahé  1 , Raluca Sterpu  2 , Laurent Bertoletti  3 , Luciano López-Jiménez  4 , Meritxell Mellado Joan  5 , Javier Trujillo-Santos  6 , Aitor Ballaz  7 , Luis Manuel Hernández Blasco  8 , Pablo Javier Marchena  9 , Manuel Monreal  10 ; RIETE Investigators
Collaborators, Affiliations

Long-Term Anticoagulant Therapy of Patients with Venous Thromboembolism. What Are the Practices?

Isabelle Mahé et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

Competing Interests: The RIETE Registry was supported with an unrestricted educational grant from Sanofi Spain and Bayer Pharma AG. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 20.05% of the total patients included in the RIETE Registry. The authors have nothing to disclose. The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Prescription of long-term therapy within the first 90 days in non-cancer patients.
Fig 2
Fig 2. Prescription of long-term therapy within the first 90 days in patients with cancer.
Fig 3
Fig 3. Evolution over years of prescriptions of the three modalities of long-term anticoagulant therapy in cancer and non-cancer patients.
See this image and copyright information in PMC

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