Patient Characteristics and Preferences Regarding Anticoagulant Treatment in Venous Thromboembolic Disease.

Background: Anticoagulants are the recommended treatment for venous thromboembolic disease (VTE). The mode of anticoagulant administration may influence compliance, and therefore the effectiveness of the treatment. Unlike in atrial fibrillation or cancer-associated thrombosis, there is only limited data on patient preferences regarding the choice of anticoagulation in VTE. This study aims to evaluate patient preferences regarding anticoagulants in terms of administration: types (oral or injectable treatment) and number of doses or injections per day. Patients and Methods: This is a national survey through a questionnaire sent by e-mail to 1936 French vascular physicians between February and April 2019. They recorded the responses for each patient admitted for VTE. Results: Three hundred and eleven (response rate of 16%) of the 1936 contacted physicians responded for 364 patients. Among these, there were 167 fully completed questionnaires. Most patients (63%) express concerns about VTE and prefer oral treatment (81.5%), justified by the ease of administration (74%) and a fear of the injections (22%). When patients were taking more than three oral treatments they statistically chose injectable treatment more often (54%) than oral treatment (25%, p = 0.002). Patients who chose injectable treatment were also older (70 ± 16 vs. 58 ± 17 years old, p = 0.001). There was no statistically difference in anticoagulation preference according to gender or to the expected duration of treatment (6 weeks, 3 months, 6 months or unlimited). When oral treatment was preferred (81%), most chose oral treatment without dose adjustment and biomonitoring (74.3%). Among them, very few (5.8%) preferred a twice-daily intake. Conclusion: Patient preference in terms of anticoagulant treatment in VTE disease is in favor of oral treatment without adjustment or biomonitoring and with once-daily intake. When an injectable treatment is chosen, a prolonged duration of treatment does not seem to be a constraint for the patient. Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT03889457].

Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases.

OBJECTIVE: Numerous guidelines have been published on the management of venous thromboembolism (VTE). However, therapeutic decision-making may prove challenging in routine clinical practice. With this in mind, multidisciplinary team (MDT) meetings have been set up in Rennes University Hospital, France. This study sought to describe the situations discussed during MDT meetings and to assess whether the meetings bring about changes in the management of these patients. MATERIALS AND METHODS: A retrospective single-center study conducted at the Rennes University Hospital included cases presented from the beginning of the MDT meetings (February 2015) up to May 2017. RESULTS: In total, 142 cases were presented in 15 MDT meetings, corresponding to a mean of 10±4 cases per meeting. Of these, 129 related to VTE patients: 33 provoked VTEs, 22 unprovoked VTEs, 49 cancer-related VTEs, and 25 unspecified VTEs. MDT meetings led to significant changes in the anticoagulation type (therapeutic, prophylactic, or discontinuation) and duration, but not in the anticoagulant choice (direct oral anticoagulants, vitamin K antagonists, heparins, etc.). CONCLUSION: Requests for MDT meetings are made for all VTE types, and these meetings have an impact on VTE management.

[Primary prophylaxis of venous thromboembolism in ambulatory cancer patients treated with antineoplastic agents]. / Prophylaxie primaire de la maladie thromboembolique veineuse chez les patients cancéreux ambulatoires traités par les antinéoplasiques.

Apart from myeloma, primary prophylaxis of venous thromboembolism (VTE) in ambulatory cancer patients treated with chemotherapy is underused, despite its proven benefit for pancreatic cancer and to a lesser extent for lung cancer. This prophylaxis has been showed to be effective for myeloma, pancreas but in absolute numbers these cancers lead to a few venous thromboembolic events. Up to date, VTE risk scores cannot be used as a discriminatory criterion to select a high-risk population that could really benefit from this prevention. VTE depends in part on oncogenic mutations of tumor cells that result in an imbalance between activation and inhibition pathways that are involved in venous thrombus formation. So, stratification of risk of VTE in cancer patients could be considered from a clinical and molecular point of view and result in a tailored prophylaxis. This "personalized medicine" that is currently used for the anti-tumor treatment of many cancers and hematological malignancies, could lead to a more effective prophylaxis of VTE in cancer patients.

Delphi-RAND consensus of the Spanish Society of Internal Medicine on the controversies in anticoagulant therapy and prophylaxis in medical diseases. INTROMBIN Project (Uncertainty in thromboprophylaxis in internal medicine). / Consenso Delphi-RAND de la Sociedad Española de Medicina Interna sobre controversias en terapia y profilaxis anticoagulante en enfermedades médicas. Proyecto INTROMBIN (INcertidumbre en TROMBoprofilaxis en Medicina INterna).

The aim of this study was to determine the opinion of internists on the management of anticoagulation and thromboembolism prophylaxis in complex clinical scenarios in which the risk-benefit ratio of surgery is narrow and to develop a consensus document on the use of drugs anticoagulant therapy in this patient group. To this end, we identified by consensus the clinical areas of greatest uncertainty, a survey was created with 20 scenarios laid out in 40 clinical questions, and we reviewed the specific literature. The survey was distributed among the internists of the Spanish Society of Internal Medicine (SEMI) and was completed by 290 of its members. The consensus process was implemented by changing the Delphi-RAND appropriateness method in an anonymous, double-round process that enabled an expert panel to identify the areas of agreement and uncertainty. In our case, we also added the survey results to the panel, a methodological innovation that helps provide additional information on the standard clinical practice. The result of the process is a set of 19 recommendations formulated by SEMI experts, which helps establish guidelines for action on anticoagulant therapy in complex scenarios (high risk or active haemorrhage, short life expectancy, coexistence of antiplatelet therapy or comorbidities such as kidney disease and liver disease), which are not uncommon in standard clinical practice.

Effect of low molecular weight heparin on venous thromboembolism disease in thoracotomy patients with cancer.

BACKGROUND: Much attention has been given to venous thromboembolism (VTE) disease, and many guidelines for prophylaxis have been published. However, there are few published data on patients who underwent thoracotomy. This study is to compare the effect of low molecular weight heparin (LMWH) combined mechanical approaches with mechanical approaches alone in prevention of VTE in the post thoracotomy cancer patients. METHODS: This study used a prospective, randomized-controlled design. Patients with cancer who were scheduled for thoracotomy were divided into two groups: group A and group B. In group A, patients were given intermittent pneumatic compression (IPC) and elastic stockings (ES) postoperatively. Additionally, at 24 hours post-operation, patients were subcutaneously injected with LMWH calcium (nadroparin calcium; GlaxoSmithKline, China) for 7 days. In group B, patients were only given postoperative IPC and ES. The primary end points were incidence of pulmonary embolism (PE), deep vein thrombosis (DVT), and the PE severity index (PESI) of PE patients. The secondary end points were hemoglobin (HGB), platelet (PLT), D-dimer, the PO2/FiO2 ratio (P/F) at postoperative day (POD) 7, the chest drainage time (CDT) and the length of stay (LOS) in hospital after operation. RESULTS: A total of 90 patients were included in the final data analysis (40 patients in group A and 50 patients in group B). At POD7, the incidence of PE, DVT and PESI was 17.50%, 5.00% and 102.14±9.87, respectively, in group A. And 8.00%, 8.00% and 97.00±4.24, respectively, in group B. There were no significant differences between two groups (all P values were >0.05). There were no significant differences of HGB, PLT, D-dimer and P/F between two groups at the 7th day post operation (all P value >0.05). CONCLUSIONS: LMWH combined mechanical prophylaxis did not significant reduced the rate of VTE in thoracotomy cancer patients.

Cuidados de Enfermagem na prevenção do tromboembolismo venoso: revisão integrativa / Nursing care in the prevention of venous thromboembolism: an integrative review

Este estudo buscou identificar na literatura científica quais os cuidados de enfermagem na prevenção do Tromboembolismo Venoso (TEV) em pacientes hospitalizados. Trata-se de uma revisão integrativa da literatura realizada nas bases de dados Public/Publish Medline (PUBMED) e Biblioteca Virtual em Saúde (BVS). Incluíram-se estudos em inglês, espanhol e português, publicados entre 2006-2016, que apresentassem ações de Enfermagem na prevenção do TEV nos pacientes hospitalizados, para a localização dos estudos utilizou-se o cruzamento dos termos "cuidados de enfermagem", "prevenção" e "tromboembolismo venoso". Predominaram os cuidados de enfermagem na prevenção do TEV categorizados em "implementação da avaliação do risco de TEV", "intervenções mecânicas e físicas" e "ensino ao paciente sobre TEV". Esses achados podem contribuir para sistematização da assistência de enfermagem pela ampliação e direcionamento das possibilidades de cuidados, além de favorecer autonomia do enfermeiro, subsidiar pesquisas de validação e reforçar a implementação de Enfermagem Vascular como área de especialidade.

This study sought to identify in the scientific literature the nursing care provided for the prevention of venous thromboembolism (VTE) in hospitalized patients. It is an integrative review of the literature conducted in the Public/Publish Medline (PUBMED) and Virtual Health Library (VHL) databases. The studies included in this review were in English, Spanish, and Portuguese and published between 2006 and 2016. They addressed nursing care in the prevention of VTE in hospitalized patients. The studies were located by cross-referencing the terms "nursing care", "prevention" and "venous thromboembolism. The predominating topics were nursing care in the prevention of VTE, categorized under "implementing VTE risk assessment", "mechanical and physical interventions", and "educating patients on VTE". These findings may contribute to the systematization of nursing care by expanding and directing care possibilities, favoring nurses' autonomy, and supporting research to validate and reinforce vascular nursing as a speciality area.

[Venous thromboembolic disease: Comparison of management practices in France, Italy and Spain]. / Comparaison en France, en Italie et en Espagne des modalités de prise en charge de la maladie thromboembolique veineuse.

BACKGROUND: Many national and international guidelines have been established for venous thromboembolic disease (VTE). Homogeneous management practices could be expected in the different European countries. To verify this hypothesis, we compared practices in France, Italy and Spain. METHOD: We used data from the international RIETE registry to compare VTE management between France, Italy and Spain. RESULTS: From 2001 January to 2011 January, patients were consecutively included in France (n=1548), Italy (n=2083) and Spain (29,824). All patients received anticoagulant treatment. Low molecular-weight heparin (LMWH) was the most frequently used drug as initial therapy in all three countries, but unfractionated heparin (UFH) was more frequently used in France and Italy than in Spain. In France, the proportion of patients receiving LMWH was lower than the proportion of patients with active cancer (cancer 22.5 %, long-term treatment with LMWH 17.4 %). A vena cava filter was significantly more frequently used in France (5.5 % in France, 3.2 % in Italy and 2 % in Spain, P<0.0001). High bleeding risk because of surgery with recent thromboembolic disease was the most frequent indication in France and Italy for vena cava filter placement (36.4 %, and 31.3 %, respectively). CONCLUSION: Despite the publication of national and international guidelines, VTE management differs among the three major European countries included in the RIETE registry, France, Italy and Spain.