Unprovoked or provoked venous thromboembolism: not the prevalent criterion to decide on anticoagulation extension in clinical practice of various countries—the prospective, international, observational WHITE study
Authors: Palareti Gualtiero , Bignamini Angelo , Cini Michela , Li Young-Jun , Urbanek Tomasz , Madaric Juraj , Bouslama Kamel , Sokurenko German Y. , Andreozzi Giuseppe M. , Matuška Jiří , Mansilha Armando , Barinov Victor ,   for the WHITE study group, Liu Jian-long , Zhang Fu-xian , Yang Tao , Ye Wei , Wang Qi , Dai Xiangchen , Li Zhen , Zhang Jian , Li Yong-jun , Wang Jin-song , He Ju , Li Yi-qing , Li Xiao-qiang , Chen Zhong , Qian Ai-min , Vogelová Monika , Modřany Poliklinika , Králová Stanislava , Hirmerová Jana , Matuška Jiří , Šárník Stanislav , Gabriel Marcin , Sydor Wojciech , Szymański Filip , Urbanek Tomasz , Lekarski Gabinet , Krasiński Zbigniew , Zieliński Adam , Sojda-Szarnecka Anna , Pelak Tomasz , Skibiński Wojciech , Hendiger Włodzimierz , Aleksiejew-Kleszczyński Tomasz , Grzela Tomasz , Szuba Andrzej , Zubilewicz Tomasz , Majewski Eugeniusz , Głowiński Jerzy , Molski Michał , Filipiak Krzysztof J. , Kucharzewski Marcin , Augusto Rita , Vaconcelos João , Cássio Isabel , Garcia Ana , Simões António , Chervyakov Yuriy , Lyudkova Larisa , Barinov Victor , Schastlivtsev Ilya , Guzhkov Oleg , Katorkin Sergey , Lazaryan Tigran , Prostov Igor , Skorobogatov Oleg , Burleva Elena , Scarubsky Anton , Petrikov Alexey , Smirnov Georgy , Fokin Alexey , Sonkin Igor , Bushnin Sergey , Murzina Elena , Zelinsky Vladimir , Bogdan Alexandr , Bredikhin Roman , Mandzhikian Ovsep , Isaev Anton , Padúchová Martina , Džupina Andrej , Štvrtinová Viera , Malá Melinda , Maďarič Juraj , Javorčíková Ľubomíra , Kmecová Dasa , Abdelkefi Meya , Bouslama Kamel , Elamri Raja , Boussema Fatma , Kechrid Chedia 
Published: July 2021

The decision on treatment after a first venous thromboembolism (VTE) to prevent recurrences may be influenced by many factors. The prospective, observational, WHITE study aimed to analyze how this issue was tackled in every-day clinical practice in various countries, which have sensibly different socio-economic conditions and healthcare systems. Doctors active in 79 Internal or Vascular clinical centers in 7 countries (China, Czechia, Poland, Portugal, Russia, Slovakia, and Tunisia) enrolled VTE patients after the maintenance treatment phase. The present report analyzed information, collected in the central database, regarding the baseline characteristics, index events, type and duration of anticoagulant therapy and decision on post-maintenance treatment. From April 2018 to December 2020, 1240 patients were enrolled, 58% with an unprovoked index event. Direct oral anticoagulants (DOACs) were used in > 85% of all cases in China, Poland, Portugal, Russia and Czechia, in 52% in Slovakia and in no patient in Tunisia. The maintenance anticoagulation lasted in average approximately 6 months. Altogether, anticoagulation was stopped in 20%, extended in about 50%, regardless of whether the event was unprovoked or provoked and shifted to antithrombotics (mainly sulodexide or aspirin) in the remaining patients. In conclusion, some differences in VTE patient management were found between countries. The provoked/unprovoked nature of the index event, instead, was not the prevalent criterion to drive the decision on extension of anticoagulation, without large variations between countries. DOACs were the most widely used anticoagulant drugs, whereas > 25% of patients received antithrombotic drugs instead of anticoagulants as extended treatment.