Approaching Venous Thromboembolism Disease (DVT) from Another Perspective: Better Management in a Multidisciplinary DVT Unit Improves Clinical Outcomes and Post Thrombotic Syndrome. One-Year Experience in Our Hospital
Authors: Suito Milagros , Cerdá Maria , Benítez Olga , Cabirta Alba , Bosch Francesc , Santamaria Amparo 
Published: November 2019

INTRODUCTION: Deep vein thrombosis (DVT) is a frequent cause or morbidity and mortality, and multiple genetic and environmental factors are involved in its etiopathogenesis. Besides investigating about personal and familiar DVT history, thrombophilia testing is often asked by physicians in order to diagnose patients, even if current validated markers won't be decisive to set duration of treatment. DVT is a multidisciplinary management entity, so it`s important to unify the diagnosis and treatment circuit with the specialists involved, in order to get a positive impact in the prognostic of the disease.

MATERIALS AND METHODS: We developed an observational and prospective study between January 2017 and December 2017 in our University Tertiary Hospital in order to register the patients with DVT that were treated in our DVT unit conformed by specialists of Hemostasis, Angiology and Intern Medicine. As secondary objectives, we wanted to know how a systematic circuit would improve the management and the complications of patients with DVT. After diagnosis in Emergency Service by Angiology -or Intern Medicine if pulmonary embolism (PE), they were sent to Hemostasis Unit within the first 7-10 days to optimize treatment according patient's necessities. After 3-6 months of starting treatment, patients were seen conjunctly by specialists of Angiology and Hemostasis to perform a doppler ultrasound and thrombophilia study in selected patients, in order to make the best decision about treatment.

RESULTS: We included 172 patients with DVT, most of them were men (56.9%), the average age was 66.4 years old, and the incidence increased from 50 years old, on. Only 26.2% had a positive personal history of DVT and 18% familiar history. We found that 75 (43.6%) patients had idiopathic DVT. About anatomical localization, the majority presented in the lower limbs (83.1%) and 12.7% associated pulmonary embolism at diagnosis. All of them started treatment with LMWH, and after the first clinical visit, 26.7% continued with it, while 51.2% changed to VKA and 22.1% to DOACs. We tested only 69 patients for thrombophilia, according to guidelines (especially in incidental DVT): 23.8% were diagnosed of antiphospholipid syndrome, 19% of S protein deficiency, 14.3% of C protein deficiency and 14.3% of prothrombin mutation, as the most common findings. Patients with positive study or antiphospholipid syndrome and 21 of the 41 patients with negative study, received permanent anticoagulation. In the conjunct visit we found a 61.1% of residual/chronic DVT, 38.4% resolved, and 0.5% of recurrence (local extension). Only 18.6% of patients had post thrombotic syndrome and we didn`t see any hemorrhagic complications during the follow up period. We also identified a reduction of almost a 50% of clinical visits because of the systematic circuit.

CONCLUSIONS: An ordered flow of patients diagnosed of DTV contributed in our clinical practice to avoid redundant hospital visits and complementary tests, and specially to release a better follow up of patients with a less percentage of bleeding (0%) and post thrombotic syndrome (18.6% vs 40% in world registries), as well as we found. It would be interesting to amplify the time of follow up, so that we would know if these benefits remain within time.

Disclosures

Bosch: Kyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; F. Hoffmann-La Roche Ltd/Genentech, Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Takeda: Honoraria, Research Funding; AstraZeneca: Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Honoraria, Research Funding; Acerta: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.