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Real-life trends of anticoagulant prescribing practices for pulmonary embolism - results of a single-center study based on the experience of a multi-profile clinical hospital

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EN
Abstrakty
EN
Acute pulmonary embolism (APE) is one of the main causes of cardiovascular deaths and anticoagulant treatment plays a key role in preventing recurrent episodes, chronic thromboembolic pulmonary hypertension (CTEPH), and deaths. The aim of this study is to assess the real-life trends and to determine factors associated with the choice of anticoagulation therapy in patients with APE. This is a single center prospective open study. We followed 178 consecutive patients admitted to the tertiary clinical center with APE proven with computed tomography (CT) scan within period of 24 months. A total number of 178 patients with APE were enrolled in the study. 48.9% of subjects were hospitalized in cardiology department. As a prolonged anticoagulant therapy 35.7% of study cohort received direct oral anticoagulants (DOACs), 35.1% LMWH, and 29.2% vitamin K antagonists (VKA), respectively. No statistically significant differences were found between the departments regarding frequency of prescribing anticoagulants (p=0.15). The multivariable analysis showed that oral anti-coagulants (OACs) were less likely to be prescribed than LMWH in patients with malignancy, history of major bleeding, serious medical condition and altered mental status. OACs were preferred over LMWH in symptoms of deep vein thrombosis (DVT). VKA were significantly less likely to be chosen than DOACs in patients with history of orthopaedics procedure. After six months anticoagulation therapy was discontinued in 24.3% of patients. Concluding, the form of anticoagulant therapy was associated with the presence of chronic diseases. LMWH was prescribed in high bleeding risk patients more frequently.
Czasopismo
Rocznik
Strony
36--45
Opis fizyczny
Bibliogr. 18 poz.
Twórcy
  • Department of Cardiology and Hypertension, Central Research Hospital, Ministry of the Interior and Administration, Warsaw (Poland)
  • Department of Pulmonary Circulation and Thromboembolic Diseases, Medical Centre of Postgraduate Education, European Health Centre Otwock, Otwock (Poland)
  • Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw (Poland)
autor
  • Department of Cardiology and Hypertension, Central Research Hospital, Ministry of the Interior and Administration, Warsaw (Poland)
  • Department of Cardiology and Hypertension, Central Research Hospital, Ministry of the Interior and Administration, Warsaw (Poland)
  • Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, (Poland)
Bibliografia
  • [1] Essien, E.O.; Rali, P.; Mathai, S.C.; Pulmonary Embolism. Med. Clin. North Am. 2019, 103, 549-564. DOI: 10.1016/j.mcna.2018.12.013
  • [2] Engelberger, R.P.; Kucher, N.; Reperfusion Treatment for Acute Pulmonary Embolism. Hamostaseologie. 2018, 38, 98-105. DOI: 10.1055/s-0038-1641717
  • [3] Torbicki, A.; Perrier, A.; Konstantinides, S.; et al; Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2008, 29, 2276-2315. DOI: 10.1093/eurheartj/ehn310
  • [4] Konstantinides, S.V.; Torbicki, A.; Agnelli, G.; et al; 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur. Heart J. 2014, 35, 3033-3069. DOI: 10.1093/eurheartj/ehu283
  • [5] Cohen, A.T.; Dobromirski, M.; Gurwith, M.M.; Managing pulmonary embolism from presentation to extended treatment. Thromb. Res. 2014, 133, 139-148. DOI: 10.1016/j.thromres.2013.09.040
  • [6] Boon, G.J.A.M.; van Rein, N.; Bogaard, H.J.; et al; Quality of initial anticoagulant treatment and risk of CTEPH after acute pulmonary embolism [published correction appears in PLoS One. 2020, 15, 0232354. DOI: 10.1371/journal.pone.0232354
  • [7] Palareti, G.; Legnani, C.; Cosmi, B.; Guazzaloca, G.; Cini, M.; Mattarozzi, S.; Poor anticoagulation quality in the first 3 months after unprovoked venous thromboembolism is a risk factor for long-term recurrence. J. Thromb. Haemost. 2005, 3, 955-961. DOI: 10.1111/j.1538-7836.2005.01330.x
  • [8] Konstantinides, S.V.; Meyer, G.; Becattini, C.; et al; The 2019 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. Eur. Heart J. 2019, 40, 3453-3455. DOI: 10.1183/13993003.01647-2019
  • [9] Kukla, P.; Kosior, D.A.; Tomaszewski, A.; et. Al. Correlations between electrocardiogram and biomarkers in acute pulmonary embolism: Analysis of ZATPOL-2 Registry. Ann Noninvasive Electrocardiol. 2017, 22, 12439. DOI: 10.1111/anec.12439
  • [10] Paczyńska, M.; Kurnicka, K.; Lichodziejewska, B.; et al.; Acute pulmonary embolism treatment with rivaroxaban results in a shorter duration of hospitalisation compared to standard therapy: an academic centre experience. Kardiol. Pol. 2016, 74, 650-656. DOI: 10.5603/KP.a2015.0253
  • [11] Cohen, A.T.; Gitt, A.K.; Bauersachs, R.; et al; The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry. Thromb. Haemost. 2017, 117, 1326-1337. DOI: 10.1160/TH16-10-0793
  • [12] Connell, N.T.; Butera, J.N.; Attending Physician Attitudes Toward Choice of Oral Anticoagulant for the Treatment of Venous Thromboembolism. R. I. Med. J. 2015, 98, 32-36. PMID: 26125477
  • [13] White, R.H.; Beyth, R.J.; Zhou, H.; Romano, P.S.; Major bleeding after hospitalization for deep-venous thrombosis. Am. J. Med. 1999, 107, 414-424. DOI: 10.1016/s0002-9343(99)00267-3
  • [14] Lip, G.Y.; Frison, L.; Halperin, J.L.; Lane, D.A.; Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J. Am. Coll. Cardiol. 2011, 57, 173-180. DOI: 10.1016/j.jacc.2010.09.024
  • [15] Ruiz-Gimenez, N.; Suarez, C.; Gonzalez, R.; et al; Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thrombosis and haemostasis. 2008, 100, 26-31. DOI: 10.1160/TH08-03-0193
  • [16] Kaliel, H.; Mior, M.; Quan, S.; et al. Retrospective Review of Prescribing Patterns in Cancer-Associated Thrombosis: A Single Center Experience in Edmonton, Alberta, Canada. Clin. Appl. Thromb. Hemost. 2021, 27, 1076029620975489. DOI: 10.1177/1076029620975489
  • [17] Dault, R.; Vanasse, A.; Blais, L.; et al; Patterns and Predictors of Use of Antico-agulants for the Treatment of Venous Thromboembolism Following Approval of Rivaroxaban. Clin. Appl. Thromb. Hemost. 2016, 22, 765-771. DOI: 10.1177/1076029615611249
  • [18] Chopard, R.; Andarelli, J.N.; Humbert, S.; et al; Prescription patterns of direct oral anticoagulants in pulmonary embolism: A prospective multicenter French registry. Thromb. Res. 2019, 174, 27-33. DOI: 10.1016/j.thromres.2018.12.013
Uwagi
Opracowanie rekordu ze środków MEiN, umowa nr SONP/SP/546092/2022 w ramach programu "Społeczna odpowiedzialność nauki" - moduł: Popularyzacja nauki i promocja sportu (2022-2023).
Typ dokumentu
Bibliografia
Identyfikator YADDA
bwmeta1.element.baztech-78e5fa7b-5009-463d-a45c-d76194df2708
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