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Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares: A clinical practice survey

Abstract : INTRODUCTION: Distal deep-vein thromboses (iDDVT) are infra-popliteal DVTs. They are as frequent but less serious than proximal DVT. Their management is debated. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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https://hal.umontpellier.fr/hal-01944077
Contributeur : Anthony Herrada <>
Soumis le : mardi 4 décembre 2018 - 13:54:14
Dernière modification le : vendredi 15 mai 2020 - 12:22:09

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Jennifer Almosni, Arthur Meusy, Pierre Frances, Daniel Pontal, Isabelle Quere, et al.. Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares: A clinical practice survey. Thrombosis Research, Elsevier, 2015, 136 (3), pp.526-530. ⟨10.1016/j.thromres.2015.06.013⟩. ⟨hal-01944077⟩

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