PMID- 16242561
OWN - NLM
STAT- MEDLINE
DCOM- 20051201
LR  - 20220321
IS  - 0741-5214 (Print)
IS  - 0741-5214 (Linking)
VI  - 42
IP  - 4
DP  - 2005 Oct
TI  - Treatment of venous thromboembolism: adherence to guidelines and impact of 
      physician knowledge, attitudes, and beliefs.
PG  - 726-33
AB  - OBJECTIVES: To assess the treatment of venous thromboembolism (VTE) in 
      hospitalized patients enrolled in a national, multicenter database. METHODS: This 
      was a retrospective, cohort study that randomly selected VTE patients from 38 
      academic/teaching, community, and Veterans Administration (VA) hospitals. The 
      study included a physician survey component. The patients selected were those 
      treated between January 2002 and June 2003 who had an ICD-9-CM code for pulmonary 
      embolus (PE), deep vein thrombosis (DVT), or pregnancy-related PE or DVT. 
      RESULTS: The study included 939 patients: 52.7% with DVT, 28.4% with PE, and 
      18.8% with PE and DVT. Mean age was 59.5 years. Risk factors included obesity 
      (body mass index > 30) in 30.1%, history of VTE in 28.0%, malignancy in 27.4%, 
      surgery in 21.1%, and immobility in 18.5%. Only 56.1% of patients were treated 
      with low-molecular-weight heparin (LMWH). Bridging from LMWH or unfractionated 
      heparin (UFH) to warfarin was completed during hospitalization in 486 (68.6%), 
      but only 246 (50.6%) had an international normalized ratio (INR) > or = 2 for 48 
      hours before discontinuation of the injectable anticoagulant. Length of stay in 
      patients discharged on bridge therapy was 4.0 +/- 3.7 days vs 8.1 +/- 5.8 days 
      for patients discharged on warfarin therapy (P < .001). Ninety-two (10.1%) 
      patients were discharged with neither oral nor injectable anticoagulation and had 
      a mean duration of treatment of only 10.6 +/- 16.2 days. Of 245 physicians 
      surveyed from participating hospitals, 84% and 53%, respectively, indicated that 
      LMWH was their preferred agent for treatment of DVT and treatment of PE. With 
      regard to warfarin, 30% did not believe it was necessary to have a therapeutic 
      INR for > or = 2 days before discontinuing LMWH or UFH, and 27% responded that it 
      was necessary to keep DVT patients in the hospital until they were therapeutic. 
      CONCLUSIONS: In this cross-section of United States hospitals, lower than 
      anticipated use of LMWH, insufficient bridging from UFH or LMWH to warfarin, and 
      continuation of anticoagulation after hospitalization were all problems 
      discovered with the treatment of VTE. Physician knowledge, attitudes, and beliefs 
      are partially responsible for the gap between actual practice and international 
      guidelines. These results suggest that hospitals should evaluate their adherence 
      to international VTE treatment guidelines and develop strategies to optimize 
      antithrombotic therapy.
FAU - Caprini, Joseph A
AU  - Caprini JA
AD  - Evanston Northwestern Healthcare and Feinberg School of Medicine, Northwestern 
      University, Chicago, Ill, USA. Jcaprini2@aol.com
FAU - Tapson, Victor F
AU  - Tapson VF
FAU - Hyers, Thomas M
AU  - Hyers TM
FAU - Waldo, Albert L
AU  - Waldo AL
FAU - Wittkowsky, Ann K
AU  - Wittkowsky AK
FAU - Friedman, Richard
AU  - Friedman R
FAU - Colgan, Kevin J
AU  - Colgan KJ
FAU - Shillington, Alicia C
AU  - Shillington AC
CN  - NABOR Steering Committee
LA  - eng
PT  - Comparative Study
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 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Anticoagulants/*administration & dosage
MH  - *Attitude of Health Personnel
MH  - Cohort Studies
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Follow-Up Studies
MH  - *Guideline Adherence
MH  - Health Knowledge, Attitudes, Practice
MH  - Health Services Research
MH  - Heparin, Low-Molecular-Weight/*administration & dosage
MH  - Humans
MH  - Injections, Subcutaneous
MH  - Male
MH  - *Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/standards/*statistics & numerical data
MH  - Probability
MH  - Pulmonary Embolism/diagnosis/*drug therapy/mortality
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Statistics, Nonparametric
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Venous Thrombosis/diagnosis/*drug therapy/mortality
MH  - Warfarin/administration & dosage
EDAT- 2005/10/26 09:00
MHDA- 2005/12/13 09:00
CRDT- 2005/10/26 09:00
PHST- 2005/02/22 00:00 [received]
PHST- 2005/05/31 00:00 [accepted]
PHST- 2005/10/26 09:00 [pubmed]
PHST- 2005/12/13 09:00 [medline]
PHST- 2005/10/26 09:00 [entrez]
AID - S0741-5214(05)00971-7 [pii]
AID - 10.1016/j.jvs.2005.05.053 [doi]
PST - ppublish
SO  - J Vasc Surg. 2005 Oct;42(4):726-33. doi: 10.1016/j.jvs.2005.05.053.