Highlights
- •A substantial proportion of VTE patients receives anticoagulants for >1 year.
- •Fatal bleeding events outweigh fatal pulmonary embolism.
- •The majority of fatal bleeds occur after the first 3 months of treatment.
Abstract
Introduction
Venous thromboembolism (VTE) carries a considerable risk of recurrence and anticoagulants
should be administered for a minimum of three months. Since little is known about
real life management of VTE, we aimed to describe current practice in the secondary
prevention of VTE.
Materials and Methods
Using the database of an international, prospective registry on patients treated for
VTE, RIETE, information was collected on risk factors for VTE and bleeding, anticoagulant
treatment, and clinical outcomes during follow up. Multivariate analysis using logistic
regression was performed to identify predictors of treatment duration.
Results
Of 6944 patients with a first episode of VTE 41.1% had unprovoked VTE, 31.8% had transient
risk factors, 27.1% had cancer. After the exclusion of patients who died during the
first year of observation, the rate of patients treated for >12 months was 55.1%, 41.9%, and 43.2%, respectively (p < 0.001). Pulmonary embolism at presentation, recurrence while on treatment, chronic
heart failure and age >65 years were independently associated with treatment for >12 months. Body weight <75 kg, anemia, cancer, and the presence of transient risk factors were associated with
treatment for 12 months or less. Major bleeding occurred more frequently than recurrent VTE in patients
with VTE secondary to transient risk factors and cancer; fatal bleeding was more frequent
than fatal recurrent PE in all subgroups.
Conclusions
We observed heterogeneous duration of anticoagulant treatment for the secondary prevention
of VTE. A substantial proportion of patients, in particular those with VTE secondary
to transient risk factors, may be exposed to a possibly unnecessary risk of bleeding.
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Article info
Publication history
Published online: February 06, 2015
Accepted:
February 2,
2015
Received in revised form:
January 20,
2015
Received:
November 30,
2014
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
