Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study
Background International guidelines recommend at least three months anticoagulation in all patients after acute venous thromboembolism (VTE) and suggest those with unprovoked events be considered for indefinite anticoagulation if the risk of recurrence is high and the risk of bleeding during treatme...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-11-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/10760296211049402 |
| _version_ | 1818952489772253184 |
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| author | Gualtiero Palareti MD Angelo A. Bignamini MD Michela Cini PhD Young-Jun Li MD Tomasz Urbanek MD Juraj Madaric MD Kamel Bouslama MD German Y. Sokurenko MD Giuseppe M. Andreozzi MD Jiří Matuška MD Armando Mansilha MD Victor Barinov MD |
| author_facet | Gualtiero Palareti MD Angelo A. Bignamini MD Michela Cini PhD Young-Jun Li MD Tomasz Urbanek MD Juraj Madaric MD Kamel Bouslama MD German Y. Sokurenko MD Giuseppe M. Andreozzi MD Jiří Matuška MD Armando Mansilha MD Victor Barinov MD |
| author_sort | Gualtiero Palareti MD |
| collection | DOAJ |
| description | Background International guidelines recommend at least three months anticoagulation in all patients after acute venous thromboembolism (VTE) and suggest those with unprovoked events be considered for indefinite anticoagulation if the risk of recurrence is high and the risk of bleeding during treatment non-high. Other authors have recently argued against using a dichotomy unprovoked/provoked events to decide on anticoagulation duration and suggest instead using overall risk factors present in each patient as the basis for deciding. Aim This sub-analysis of the WHITE study aimed at assessing the reasons for the treatment decisions taken by doctors in different countries. Results 1240 patients were recruited in 7 countries (China, Czechia, Poland, Portugal, Russia, Slovakia, and Tunisia). Anticoagulation was extended in 51.7% and 49.3% of patients with unprovoked or provoked events (n.s.); stopped in 15.4% versus 28.9% ( P < .0001), and changed to antithrombotic drugs (sulodexide or aspirin) in 32.9% versus 21.8% ( P < .0001). In the 430 subjects with isolated distal deep vein thrombosis (IDDVT) anticoagulation was stopped in 34.4%, continued in 37.0% (mainly those with post-thrombotic syndrome [PTS]) and switched to antithrombotics in the balance. High risk of recurrence was the most prevalent reason (>83% of cases) given to continue anticoagulation, regardless of nature and site of the index events, followed by risk of bleeding and presence of PTS signs. Conclusion On average, attending physicians estimated the risk of recurrence in real life conditions, and the consequent therapeutic decision, using all the information available, not limiting to the location or nature of the index event. |
| first_indexed | 2024-12-20T09:51:12Z |
| format | Article |
| id | doaj.art-9dc7d1f96b004974aa66dfd6b56b529e |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-12-20T09:51:12Z |
| publishDate | 2021-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-9dc7d1f96b004974aa66dfd6b56b529e2022-12-21T19:44:36ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232021-11-012710.1177/10760296211049402Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE StudyGualtiero Palareti MD0Angelo A. Bignamini MD1Michela Cini PhD2Young-Jun Li MD3Tomasz Urbanek MD4Juraj Madaric MD5Kamel Bouslama MD6German Y. Sokurenko MD7Giuseppe M. Andreozzi MD8Jiří Matuška MD9Armando Mansilha MD10Victor Barinov MD11 Arianna Anticoagulazione Foundation, Bologna, Italy School of Specialization in Hospital Pharmacy, , Milan, Italy Arianna Anticoagulazione Foundation, Bologna, Italy Peking Union Medical College, , Beijing, China , Katowice, Poland Clinic of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia Faculty of Medicine of Tunis, , Tunis, Tunisia North-West Mechnikov State Medical University, St. Petersburg, Russia Angiology Unit, , Padova, Italy Clinical Trial Centre, Hodonin, Czechia , Porto, Portugal Clinical Hospital N. 1 “Volynskaya”, Moscow, RussiaBackground International guidelines recommend at least three months anticoagulation in all patients after acute venous thromboembolism (VTE) and suggest those with unprovoked events be considered for indefinite anticoagulation if the risk of recurrence is high and the risk of bleeding during treatment non-high. Other authors have recently argued against using a dichotomy unprovoked/provoked events to decide on anticoagulation duration and suggest instead using overall risk factors present in each patient as the basis for deciding. Aim This sub-analysis of the WHITE study aimed at assessing the reasons for the treatment decisions taken by doctors in different countries. Results 1240 patients were recruited in 7 countries (China, Czechia, Poland, Portugal, Russia, Slovakia, and Tunisia). Anticoagulation was extended in 51.7% and 49.3% of patients with unprovoked or provoked events (n.s.); stopped in 15.4% versus 28.9% ( P < .0001), and changed to antithrombotic drugs (sulodexide or aspirin) in 32.9% versus 21.8% ( P < .0001). In the 430 subjects with isolated distal deep vein thrombosis (IDDVT) anticoagulation was stopped in 34.4%, continued in 37.0% (mainly those with post-thrombotic syndrome [PTS]) and switched to antithrombotics in the balance. High risk of recurrence was the most prevalent reason (>83% of cases) given to continue anticoagulation, regardless of nature and site of the index events, followed by risk of bleeding and presence of PTS signs. Conclusion On average, attending physicians estimated the risk of recurrence in real life conditions, and the consequent therapeutic decision, using all the information available, not limiting to the location or nature of the index event.https://doi.org/10.1177/10760296211049402 |
| spellingShingle | Gualtiero Palareti MD Angelo A. Bignamini MD Michela Cini PhD Young-Jun Li MD Tomasz Urbanek MD Juraj Madaric MD Kamel Bouslama MD German Y. Sokurenko MD Giuseppe M. Andreozzi MD Jiří Matuška MD Armando Mansilha MD Victor Barinov MD Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study Clinical and Applied Thrombosis/Hemostasis |
| title | Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study |
| title_full | Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study |
| title_fullStr | Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study |
| title_full_unstemmed | Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study |
| title_short | Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study |
| title_sort | anticoagulation duration after first venous thromboembolism real life data from the international observational white study |
| url | https://doi.org/10.1177/10760296211049402 |
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