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An international survey of clinicians regarding their management of venous thromboembolism following the initial 3–6 months of anticoagulation

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Abstract

After an initial treatment period for venous thromboembolism (VTE), indefinite anticoagulation may be considered, depending upon individual risks. The aim of the study was to determine if there is consensus amongst clinicians that manage VTE regarding which patients require 3–6 months versus indefinite anticoagulation. The importance of VTE site and severity in decision making was also evaluated. An international survey of clinicians involved in VTE management was undertaken. Respondents were asked about long-term treatment of six patients that had completed 3–6 months initial anticoagulation. These included four cases of VTE not associated with a major reversible risk factor and two control cases; one unprovoked VTE and one VTE associated with a major reversible risk factor. For consensus, there was a pre-defined equivalence boundary whereby at least 70% of clinicians had to decide either to stop or consider indefinite anticoagulation for each case. 351 responses were collected. In the control cases, there was a ≥ 95% consensus on long-term management (stop versus indefinite anticoagulation). In three of the four test cases, there was no consensus about duration of anticoagulation. In case 3, 78% (99% confidence interval 73–84%) would stop anticoagulation after 3–6 months. When analysed by grade or specialty of doctor, a lack of consensus remained. Opinion on whether site or severity of VTE influenced decision making was variable. For patients with unprovoked VTE or VTE associated with a major transient risk factor there is treatment consensus. For the remainder, there is a lack consensus regarding the need for indefinite anticoagulation.

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Acknowledgements

We thank the following organisations who helped with circulating the survey to our clinical colleagues; Thrombosis UK, Thrombosis Ireland, HaemSTAR, British Thoracic Society, VTE Dublin, INViTE and INVENT-VTE. We thank our colleagues who completed the survey and that helped circulate it, especially Professor Beverley Hunt, Professor Mike Makris, Professor Saskia Middeldorp, Professor Fionnuala Ní Áinle, Dr Michelle Lavin & Professor Roopen Arya.

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Department of Acute Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    E. Banham-Hall

  2. Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    A. Allison

  3. Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    A. Santarsieri & W. Thomas

  4. Department of Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    M. Gohel

  5. Comprehensive Coagulation Centre, Cork University Hospital, Cork, Ireland

    M. P. Crowley

  6. Department of Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    K. Sheares

  7. Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK

    K. Sheares

Authors
  1. E. Banham-Hall
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  2. A. Allison
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  3. A. Santarsieri
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  4. M. Gohel
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  5. M. P. Crowley
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  6. K. Sheares
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  7. W. Thomas
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Contributions

EB-H, AS, KS, MC, WT designed the study and had intellectual input. AA performed statistical analysis. EB-H created the online survey and code to randomise the question order. MG has had intellectual input and critically appraised the manuscript. WT wrote the first draft of the manuscript and all authors approved the final manuscript.

Corresponding author

Correspondence to M. P. Crowley.

Ethics declarations

Conflict of interest

EB-H works full time for the NHS but is seconded 50% of his time to GSK. AA, AS, MG, MC—none to declare. KS—educational support from Actelion, Bayer and GSK, advisory board and speaker's honorarium from Actelion. WT—honorarium from Bayer and Pfizer & advisory board for Daiichi Sankyo.

Ethical approval

This study had approval from the Cambridge University Hospitals (CUH) research and development (R&D) department and Human Research Authority (IRAS: 266358). National Health Service research ethics committee approval was not required because this was a clinician survey; however, the study had a favourable internal ethical review at the CUH R&D department.

Consent to participate

Consent to participate was gained by all participants on the online platform prior to taking the survey.

Consent for publication

Participants consented to publication.

Code availability

Statistical package R version 3.6.1 on a windows computer.

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Banham-Hall, E., Allison, A., Santarsieri, A. et al. An international survey of clinicians regarding their management of venous thromboembolism following the initial 3–6 months of anticoagulation. J Thromb Thrombolysis 51, 17–24 (2021). https://doi.org/10.1007/s11239-020-02193-6

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  • DOI: https://doi.org/10.1007/s11239-020-02193-6

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