PMID- 14603194
OWN - NLM
STAT- MEDLINE
DCOM- 20031204
LR  - 20220318
IS  - 0741-5214 (Print)
IS  - 0741-5214 (Linking)
VI  - 38
IP  - 5
DP  - 2003 Nov
TI  - The management and outcome of acute venous thromboembolism: a prospective 
      registry including 4011 patients.
PG  - 916-22
AB  - OBJECTIVE: To obtain a realistic overview of management and clinical outcomes of 
      patients with venous thromboembolism (VTE) in Spain on the basis of data from a 
      national multicenter registry. METHODS: A prospective registry was initiated in 
      Spain in March 2001. Data were collected from patients with objectively confirmed 
      deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and entered into the 
      online registry by physicians who were responsible for the management of these 
      patients. RESULTS: As of August 2002, 4011 patients with confirmed VTE were 
      included in the registry: 60% with DVT, 23% with PE, and 17% with both DVT and 
      PE. Diagnostic methods for VTE included compression ultrasonography (86%), 
      venography (10%), V/Q lung scans (42%), computed tomography scan (28%), and 
      pulmonary angiography (0.9%). D-dimer testing was performed in 61% of cases and 
      was positive in 92% of patients with confirmed VTE. The majority of DVT (95%) 
      were located in the lower extremities (82% proximal and 4% bilateral), while 4.8% 
      were located in the upper extremities or neck veins. Most patients (90.5%) were 
      admitted to hospital. In the acute phase, treatment consisted of low molecular 
      weight heparin (LMWH) in 88%, unfractionated heparin (UFH) in 11%, and 
      fibrinolysis in 0.8%. Cava filters were inserted in 2% of patients, mainly 
      because of active bleeding (13%), increased hemorrhagic risk (38%), or recurrent 
      VTE (29%). Absolute bed rest was recommended to 63% of patients. Secondary 
      prevention of VTE included oral anticoagulants (75%) and LMWH (24.5%). 
      Therapeutic compression stockings were prescribed to 53% of patients at the time 
      of hospital discharge. Regarding the main clinical outcomes during an average 
      (+/-SD) follow-up period of 156 +/- 95 days, 19% had adverse events: 12.5% of 
      patients died, 5.5% had clinically confirmed VTE recurrence, and 9.8% suffered 
      bleeding complications (44% with major bleeding). CONCLUSIONS: This prospective 
      observational multicenter registry provides a large database reflecting the 
      actual day-to-day clinical practice regarding VTE management in a European 
      country. The most important findings were the increasing use of spiral computed 
      tomography for PE diagnosis, the unexpectedly high proportion of patients 
      admitted to hospital despite the use of LMWH in almost 90% of cases in the acute 
      phase, and the utilization of LMWH for secondary prevention in almost 25% of 
      cases. On the other hand, this large-scale prospective registry permits on-line 
      consultation of high-risk situations to assess how difficult cases were treated 
      and what their outcomes were. This will provide a most useful tool for the 
      practicing physician responsible for the management of VTE patients.
FAU - Arcelus, Juan I
AU  - Arcelus JI
AD  - Hospital Virgen de las Nieves, University of Granada, Spain.
FAU - Caprini, Joseph A
AU  - Caprini JA
FAU - Monreal, Manuel
AU  - Monreal M
FAU - Suarez, Carmen
AU  - Suarez C
FAU - Gonzalez-Fajardo, Jose
AU  - Gonzalez-Fajardo J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Heparin/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Professional Practice/*statistics & numerical data
MH  - Prospective Studies
MH  - Pulmonary Embolism/diagnosis/*therapy
MH  - *Registries
MH  - Spain/epidemiology
MH  - Thrombolytic Therapy/methods
MH  - Treatment Outcome
MH  - Vena Cava Filters
MH  - Venous Thrombosis/diagnosis/*therapy
EDAT- 2003/11/07 05:00
MHDA- 2003/12/05 05:00
CRDT- 2003/11/07 05:00
PHST- 2003/11/07 05:00 [pubmed]
PHST- 2003/12/05 05:00 [medline]
PHST- 2003/11/07 05:00 [entrez]
AID - S0741521403007894 [pii]
AID - 10.1016/s0741-5214(03)00789-4 [doi]
PST - ppublish
SO  - J Vasc Surg. 2003 Nov;38(5):916-22. doi: 10.1016/s0741-5214(03)00789-4.