Inconsistencies in the planning of the duration of anticoagulation among outpatients with acute deep-vein thrombosis

David Spirk; Marc Husmann; Torsten Willenberg; Martin Banyai; Ulrich Frank; Thomas Baldi; Beatrice Amann-Vesti; Iris Baumgartner; Nils Kucher

doi:10.1160/TH10-08-0506

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 105(02): 239-244
DOI: 10.1160/TH10-08-0506

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Inconsistencies in the planning of the duration of anticoagulation among outpatients with acute deep-vein thrombosis

Results from the OTIS-DVT Registry

Authors

David Spirk^*

¹Medical Department, sanofi-aventis (suisse) sa, Meyrin, Switzerland
Marc Husmann^*

²Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
Torsten Willenberg

³Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
Martin Banyai

⁴Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
Ulrich Frank

⁵Department of Internal Medicine, Cantonal Hospital Chur, Chur, Switzerland
Thomas Baldi

⁶Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
Beatrice Amann-Vesti

²Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
Iris Baumgartner

³Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
Nils Kucher

³Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland

Abstract

Summary

Three-month anticoagulation is recommended to treat provoked or first distal deep-vein thrombosis (DVT), and indefinite-duration anticoagulation should be considered for patients with unprovoked proximal, un-provoked recurrent, or cancer-associated DVT. In the prospective Out-patient Treatment of Deep Vein Thrombosis in Switzerland (OTIS-DVT) Registry of 502 patients with acute objectively confirmed lower extremity DVT (59% provoked or first distal DVT; 41% unprovoked proximal, unprovoked recurrent, or cancer-associated DVT) from 53 private practices and 11 hospitals, we investigated the planned duration of anticoagulation at the time of treatment initiation. The decision to administer limited-duration anticoagulation therapy was made in 343 (68%) patients with a median duration of 107 (interquartile range 91–182) days for provoked or first distal DVT, and 182 (interquartile range 111–184) days for unprovoked proximal, unprovoked recurrent, or cancer-associated DVT. Among patients with provoked or first distal DVT, anticoagulation was recommended for <3 months in 11%, ≥3 months in 63%, and for an indefinite period in 26%. Among patients with unprovoked proximal, unprovoked recurrent, or cancer-associated DVT, anticoagulation was recommended for <6 months in 22%, 6–12 months in 38%, and for an indefinite period in 40%. Overall, there was more frequent planning of indefinite-duration therapy from hospital physicians as compared with private practice physicians (39% vs. 28%; p=0.019). Considerable inconsistency in planning the duration of anticoagulation therapy mandates an improvement in risk stratification of outpatients with acute DVT.

Keywords

Deep-vein thrombosis - anticoagulants - outpatient treatment

Full Text

References

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