Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is increasingly recognised as a chronic disease with significant recurrence rates and resulting morbidity or mortality. The availability of direct oral anticoagulants (DOACs), listed by Pharmaceutical Benefits Scheme in 2013 in Australia, has changed the landscape of VTE management.
Aims: To characterise the real-world experience of VTE management in our study population.
Methods: Retrospective evaluation of VTE events managed at Northern Health, Melbourne, Australia from January 2012 to June 2019 (median follow-up 5.6 years). The analysis included patient demographics, associated risk factors, management and outcomes.
Results: There were 2055 VTE events analysed involving 1932 individuals (median age 65 years (range 16-102); 53% females). These events included 1450 (71%) DVTs, 965 (47%) PEs and 360 (18%) with concurrent DVT/PE. 337 (16%) patients had active malignancy. 60% events (n=1233) were provoked with the most common provoking factor being injury/immobility (n=486, 24%) followed by surgery (n=344, 17%). 280 (14%) events occurred despite being on some form of anticoagulation. The median duration of anticoagulation was 6 months. 872 (42%) cases were managed with warfarin, 365 (18%) with enoxaparin and 673 (33%) with a DOAC. 221 (11%) patients experienced recurrent VTE while 75 patients (4%) experienced clinically significant major bleeding (p<0.001). Patients on warfarin and/or enoxaparin had higher rates of clinically significant major bleeding compared to DOACs (31/872 on warfarin (4%) vs 30/365 on enoxaparin (8%) vs 12/673 on DOAC (2%), p<0.001). Thrombosis and bleeding-related mortalities were comparable (30 (1.6%) vs 22 (1.1%), p=0.26). 68 patients (4%) were diagnosed with subsequent malignancies.
Conclusions: The recurrent thrombosis rate was 11% with a 4% rate of clinically significant major bleeding in this study. Bleeding rates were lower in patients treated with DOAC supporting the use of DOACs as first-line therapy in appropriately selected patients.
To cite this abstract in AMA style:Lui B, Kwok A, Lai J, Khattak Z, Ho P, Lim HY. A Real-world Experience of Venous Thromboembolism (VTE) Management in Australia [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/a-real-world-experience-of-venous-thromboembolism-vte-management-in-australia/. Accessed January 26, 2022.
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