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Treatment and Secondary Prevention of Venous Thromboembolism in Real Clinical Practice Based on Health Care Professional Survey

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Aim. To assess the duration of the anticoagulant treatment of venous thromboembolism (VTE) in various categories of patients in real clinical practice through survey of practitioners, as well as correspondence of the duration with current clinical guidelines.

Material and methods. Data obtained from electronic survey of practicing surgeons as part of a commercial brand assessment (Brand Adoption Monitor) was studied. Survey was carried out by the "Validata” analytical agency at the request and with the financial support of Bayer. Inpatient and outpatient vascular surgeons, as well as general outpatient surgeons were invited to complete the electronic questionnaire. The number of interviewed specialists was 100: 50 inpatient vascular surgeons and 50 outpatient specialists, among whom the share of vascular surgeons (phlebologists, angi-ologists) was about 20%. The study was completed in 20 cities of Russia with a population of at least 200,000 people from all federal districts except the North Caucasus and the Republic of Crimea. The selection criteria for participants were: work experience in the specialty ≥3 years, work experience at the current organization >6 months, ≥5 patients with VTE during in the last month.

Results. In total, 104 doctors were surveyed during the period from December 11, 2019 to January 20, 2020, of which 50 were inpatient vascular surgeons and 54 were from outpatient setting. According to the survey of vascular surgeons in hospitals, 75% (6 [5;10]) of patients were hospitalized with a primary episode of VTE and 25% (2 [1;4]) with a recurrent thrombotic event. In an outpatient surgeon, 27.5% (3 [2;5]) of patients were treated in an outpatient setting without hospitalization, 34.7% (3 [2;5]) came to an appointment immediately after discharge from the hospital and 38.8% (2 [1;4]) were a repeat visit regarding a previous VTE. Most often, surgeons observed episodes of clinically unprovoked VTE in 27.3% of cases, thrombotic events provoked by major transient risk factors were 12.2%, event provoked by small transient risk factors were 13.3% and events provoked by small persistent risk factors were 12.6%, while cancer-associated thrombosis represented 13.5%. Most surgeons chose to prescribe anticoagulant therapy beyond 3 months. About half of the specialists prescribed therapy for a year or longer for cancer-associated thrombosis and recurrent VTE. When treating the first episode of clinically unprovoked VTE, about half of the respondents chose anticoagulation for a period of 3 to 6 months. About 60% of specialists prescribed anticoagulant therapy for a period of 3 to 6 months to patients with minor transient or persistent risk factors and patients with VTE provoked by major transient risk factor (trauma or surgery).

Conclusion. Correspondence of the duration of anticoagulant therapy in real clinical practice with the international clinical guidelines varies within 450% range and, on average, does not exceed 30%. This discrepancy was both in situations when the duration of therapy was lower than recommended, but also in situations when treatment extension would not have been recommended.

About the Authors

K. V. Lobastov
Pirogov Russian National Research Medical University
Russian Federation

Kirill U Lobastov - eLibrary SPIN 2313-0691.


A. R. Navasardyan
Bayer JSC
Russian Federation

Artur R. Navasardyan – eLibrary SPIN 8497-8485.


I. V. Schastlivtsev
Pirogov Russian National Research Medical University
Russian Federation

Ilya V. Schastiivtsev - eLlbrary SPIN 7329-6994.



1. Raskob GE, Angchaisuksiri P, Blanco AN, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34(1 1):2363-71. DOI:10.1161/atvbaha.114.304488.

2. Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res. 2016;1 18(9):1 340-7. DOI:10.1161/circresaha.115.306841.

3. Martin KA, Molsberry R, Cuttica MJ, et al. Time Trends in Pulmonary Embolism Mortality Rates in the United States, 1 999 to 2018. J Am Heart Assoc. 2020;9(17):e01 6784. DOI:10.1161/JAHA.120.016784.

4. Brahmandam A, Abougergi MS, Ochoa Chaar CI National trends in hospitalizations for venous thromboembolism. J Vasc Surg Venous Lymphat Disord. 2017;5(5):621 -629.e2. DOI:10.1016/j.jvsv.2017.04.006.

5. Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125(1):1-7. DOI:10.7326/0003-4819-125-1-199607010-00001.

6. Khan F, Rahman A, Carrier M, et al. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. BMJ. 2019;366:l4363. DOI:10.1136/bmj.l4363.

7. Mearns ES, Coleman CI, Patel D, et al. Index clinical manifestation of venous thromboembolism predicts early recurrence type and frequency: a meta-analysis of randomized controlled trials. J Thromb Haemost. 2015;13(6):1043-52. DOI:1043-52.10.1111/jth.12914.

8. Heit JA, Lahr BD, Ashrani AA, et al. Predictors of venous thromboembolism recurrence, adjusted for treatments and interim exposures: a population-based case-cohort study. Thromb Res. 2015;1 36(2):298-307. DOI:10.1016/j.thromres.2015.06.030.

9. Heit JA, Silverstein MD, Mohr DN, et al. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med. 1999;1 59(5):445-53. DOI:10.1001/archinte.159.5.445.

10. Prandoni P, Ghirarduzzi A, Prins MH, et al. Venous thromboembolism and the risk of subsequent symptomatic atherosclerosis. J Thromb Haemost. 2006;4(9):1891-6. DOI:10.1111/j.1538-7836.2006.02058.x.

11. Prandoni P, Lensing AW, Prins MH, et al. Residual vein thrombosis and the risk of subsequent serious complications. Thromb Res. 2015;136(1):178-9. DOI:1016/j.thromres.2015.04.038.

12. Bilora F, Ceresa M, Milan M, et al. The impact of deep vein thrombosis on the risk of subsequent cardiovascular events: a 14-year follow-up study, Int Angiol. 2017;36(2):1 56-9. DOI:10.23736/s0392-9590.16.03664-6.

13. Golemi I, Cote L, Iftikhar O, et al. Incidence of major adverse cardiovascular events among patients with provoked and unprovoked venous thromboembolism: Findings from the Registro Informatizado de Enfermedad Tromboembolica Registry. J Vasc Surg Venous Lymphat Disord. 2020;8(3):353-359.e1. DOI:10.1016/j.jvsv.2019.03.011.

14. Young L, Ockelford P., Milne D, et al. Post-treatment residual thrombus increases the risk of recurrent deep vein thrombosis and mortality. Journal of Thrombosis and Haemostasis. 2006;4(9):1919-24. DOI:10.1111/j.1538-7836.2006.02120.x.

15. Savory L, Harper P, Ockelford P. Posttreatment ultrasound-detected residual venous thrombosis: a risk factor for recurrent venous thromboembolism and mortality. Curr Opin Pulm Med. 2007;13(5):403-8. DOI:10.1097/MCP.0b013e32821642fb.

16. Bokeriya LA, Zatevakhin II, Kirienko AI, et al. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTE). Flebologiya, 2015. 9(4-2):1-52 (In Russ.)

17. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;1 49(2):31 5-52. DOI:10.1016/j.chest.2015.11.026.

18. Konstantinides SV, Meyer G, Becattini C, et al. E.S.C.S.D., 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. DOI:10.1093/eurheartj/ehz405.

19. Key NS, Khorana AA, Kuderer NM, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020;38(5):496-520. DOI:10.1200/jco.19.01461.

20. Ageno W, Samperiz A, Caballero R, et al. Duration of anticoagulation after venous thromboembolism in real world clinical practice. Thromb Res. 2015;135(4):666-72. DOI:10.1016/j.thromres.2015.02.001.

21. Bikdeli B, Jimenez D, Hawkins M, et al. Design and Methodology of the Computerized Registry of Patients with Venous Thromboembolism (RIETE). Thromb Haemost. 2018;118(1 ):214-24. DOI:10.1160/th17-07-0511.

22. Jones TL, Baxter MA, Khanduja V. A quick guide to survey research. Ann R Coll Surg Engl. 2013;95(1):5-7. DOI:10.1308/003588413x13511609956372.

23. Boutitie F, Pinede L, Schulman S, et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants' data from seven trials. BMJ. 2011 ;342:d3036. DOI:10.1136/bmj.d3036.

24. Nieto JA, Mora D, Bikdeli B, et al. Thirty-day outcomes in patients with proximal deep vein thrombosis who discontinued anticoagulant therapy prematurely. Thrombosis Research. 2020;189:61-8. DOI:10.1016/j.thromres.2020.03.001.

25. Lobastov KV. Contemporary approaches to determine the duration of anticoagulant therapy for venous thromboembolism. Khirurgiia. 2019;(5):94-1 03 (In Russ.) DOI:10.17116/hirur-gia20190519426.

26. Baglin T, Luddington R, Brown K, et al. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet. 2003;362(9383):523-6. DOI:10.1016/S0140-6736(03)14111-6.

27. Le Gal G, Kovacs MJ, Carrier M, et al. Risk of recurrent venous thromboembolism after a first oestrogen-associated episode. Data from the REVERSE cohort study. Thromb Haemost. 2010;104(3):498-503. DOI:10.1160/th09-10-0685.

28. Tosetto A, Iorio A, Marcucci M, et al. Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). J Thromb Haemost. 2012;10(6):1019-25. DOI:10.1111/j.1538-7836.2012.04735.x.

29. Prins MH, Lensing AWA, Prandoni P, et al. Risk of recurrent venous thromboembolism according to baseline risk factor profiles. Blood Adv. 2018;2(7):788-96. DOI:10.1182/bloodadvances.2018017160.

30. Finazzi G, Brancaccio V, Moia M, et al. Natural history and risk factors for thrombosis in 360 patients with antiphospholipid antibodies: a fouryear prospective study from the Italian Registry. Am J Med. 1996;1 00(5):530-6. DOI:10.1016/s0002-9343(96)00060-5.

31. Crowther MA, Ginsberg JS, Julian J, et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med. 2003;349(12):1 133-8. DOI:10.1056/NEJMoa035241.

32. Finazzi G, Marchioli R, Brancaccio V, et al. A randomized clinical trial of high-intensity warfarin vs. conventional antithrombotic therapy for the prevention of recurrent thrombosis in patients with the antiphospholipid syndrome (WAPS). J Thromb Haemost. 2005;3(5):848-53. DOI:10.1111/j.15387836.2005.01340.x.

33. Fazili M, Stevens SM, Woller SC. Direct oral anticoagulants in antiphospholipid syndrome with venous thromboembolism: Impact of the European Medicines Agency guidance. Research and Practice in Thrombosis and Haemostasis. 2020;4(1):9-12. DOI:10.1002/rth2.12287.

34. Bauersachs R, Langer F, Kalka C, et al. Treatment of the antiphospholipid syndrome with direct oral anticoagulants Position statement of German societies. Vasa. 2019;48(6):483-486. DOI:10.1024/0301-1526/a000815.

35. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S-e496S. DOI:10.1378/chest.11-2301.

36. Mai V, Bertoletti L, Cucherat M, et al. Extended anticoagulation for the secondary prevention of venous thromboembolic events: An updated network meta-analysis. PLoS One. 2019;14(4):e0214134. DOI:10.1371/journal.pone.0214134.

37. Bounameaux H, Haas S, Farjat AE, at al. Comparative effectiveness of oral anticoagulants in venous thromboembolism: GARFIELD-VTE. Thromb Res. 2020;191:103-112. DOI:10.1016/j.thromres.2020.04.036.


For citations:

Lobastov K.V., Navasardyan A.R., Schastlivtsev I.V. Treatment and Secondary Prevention of Venous Thromboembolism in Real Clinical Practice Based on Health Care Professional Survey. Rational Pharmacotherapy in Cardiology. 2021;17(3):376-385. (In Russ.)

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