Abstract Number: PB2490
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: We focus on this VTE group since it comprises relatively frequent situations that affect young patients with events categorized as “associated with a weak risk factor” (1). There is controversy about the study of underlying thrombophilia and subsequent management in this group. The easy access to the study of thrombophilia and the lack of protocolization determines not only higher health costs but also inappropriate treatments.
Aims: To know the clinical practice in our country.
Methods: This is a descriptive study. We designed an online, anonymous survey, aimed at internists, hematologists and gynecologists. Based on defined clinical vignettes, the study of thrombophilia and length of treatment according to its presence or absence were assessed. We previously defined what we consider to be a completely correct study (tables 1-2).
Results: 178 specialists answered the survey: 86 internists, 46 hematologists and 46 gynecologists.
Regarding vignette 1: 100% of gynecologists and 89% of hematologists and internists decided to study thrombophilia. Of the internists and hematologists who studied thrombophilia, only 25.4% conducted a correct study (table 1). Length of anticoagulation: 5% of internists and hematologists would choose indefinite anticoagulation. The percentage increases to 24% if the patient was heterozygous for FV Leiden.
Regarding vignette 2: 93.5% of gynecologists and 75% of hematologists and internists decided to study thrombophilia. Only 19,2% of the internists and hematologists who studied thrombophilia, conducted a correct study (table 2). Length of anticoagulation: 5% of the internists and hematologists would prescribe indefinite anticoagulation. The percentage increases to 15% if the patient was heterozygous for GP20210A.
Conclusions: Although there are some recommendations (2-3), this group of patients is managed in a very heterogeneous way. This leads to important implications for quality of life and health expenditure. This survey highlights the value given to low-risk thrombophilia to define the length of anticoagulation.
Vignette 1 |
You assist a 25-year-old female patient with no personal or family history of VTE. She had started combined oral contraceptives 3 months ago. She developed an unprovoked proximal DVT. |
The survey included questions about thrombophilia study and length of anticoagulation if Factor V Leiden was positive or negative. |
Appropriate study: *AAF: at any time without warfarin *FVL and GP 20210A: at any time *Protein S and C: away from the acute event and without warfarin *Antithrombin: at any time without heparin |
[Table 1. Vignette 1]
Vignette 2 |
You assist a 28-year-old female patient with no personal or family history of VTE. While 20 weeks pregnant, she is diagnosed with PE (pulmonary embolism) |
The survey included questions about thrombophilia study and length of anticoagulation if GP20210A was positive or negative. |
Appropriate study: *AAF: at any time without warfarin *FVL and GP 20210A: at any time *Protein S and C: 6 weeks after delivery and without warfarin *Antithrombin: at any time without heparin |
[Table 2. Vignette 2]
To cite this abstract in AMA style:
Mérola V, Zubiaurre V, Grille S, Pizzarossa AC, Nicassio L, Lorenzo M, Spangenberg MN, Dos Santos G, Díaz L, Guillermo C, Martínez R. National Survey about Management of Venous Thromboembolism (VTE) Associated with Pregnancy / Puerperium or Oral Contraceptives in Uruguay [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/national-survey-about-management-of-venous-thromboembolism-vte-associated-with-pregnancy-puerperium-or-oral-contraceptives-in-uruguay/. Accessed March 22, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/national-survey-about-management-of-venous-thromboembolism-vte-associated-with-pregnancy-puerperium-or-oral-contraceptives-in-uruguay/