Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares: A clinical practice survey. Issue 3 (September 2015)

• Record Type: Journal Article
• Authors: Almosni, Jennifer; Meusy, Arthur; Frances, Pierre; Pontal, Daniel; Quéré, Isabelle; Galanaud, Jean-Philippe
• Is Part Of: Thrombosis research. Volume 136:Issue 3(2015)
• Page Start: 526
• Page End: 530
• Publication Date: 2015-09
• Subjects: Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2015.06.013
• Languages: English
• ISSNs: 0049-3848

Abstract

<abstract abstract-type="author" id="ab0005"> <title id="st0005">Abstract</title> <sec> <title id="st0010">Introduction</title> <p id="sp0005">Distal deep-vein thromboses (iDDVT) are infra-popliteal DVTs. They are as frequent but less serious than proximal DVT. Their management is debated.</p> </sec> <sec> <title id="st0015">Methods</title> <p id="sp0010">Clinical practice survey among a random selection of 111 general practitioners (GP) and 56 vascular medicine physicians (VMP) working in Languedoc-Roussillon (France) to assess and compare iDDVTs management by GP and VMP.</p> </sec> <sec> <title id="st0020">Results</title> <p id="sp0015">In case of DVT, GP manage their patients alone in 35% of cases. In case of collaborative management, VMP initiate and stop anticoagulants (> 74% of cases) whereas GP monitor anticoagulation (> 76% of cases). With iDDVT, there was no difference between GP and VMP in terms of use (94% vs. 92%) and intensity of anticoagulation (full dose: 99%vs.100%). Duration of anticoagulation differed: GP modulated less frequently duration of anticoagulation in presence of a transient risk factor (58% vs. 90%, p < 0.05) or according to the deep-calf or muscular location of iDDVT (6% vs. 36%, p < 0.05) and treated more frequently iDDVT as long as proximal DVT (49% vs. 13%, p < 0.05). When comparing GP, there was no significant difference in terms of therapeutic management between those who used to manage DVT alone and those who used to manage in collaboration with a thrombosis expert.</p> </sec> <sec> <title id="st0025">Conclusion</title> <p id="sp0020">Treatment of iDDVT differed between GP and VMP. Half of GP don't modulate treatment according to anatomical location or to the provoked/unprovoked character of DVT. Given the low frequency of exposure to DVT in general practice, systematic referral to a thrombosis expert rather than continuous medical formation program seems appropriate to improve management.</p> </sec> </abstract>