TY - JOUR
T1 - Deferring diagnostic evaluation of suspected deep vein thrombosis using direct oral anticoagulant or low-molecular-weight heparin as a single dose anticoagulant
T2 - A prospective real-world study in a regionwide care pathway
AU - Luu, Inge H.Y.
AU - Appelboom, Yael
AU - Willems, Jeresa I.A.
AU - Gielen, Robbert Jan C.A.M.
AU - Lobbes, Marc B.I.
AU - Külcü, Kemal
AU - ten Cate, Hugo
AU - Peeters, Jos
AU - Palmen, Jan
AU - Buijs, Jacqueline
AU - Jie, Kon Siong G.
AU - van Kampen, Roel J.W.
AU - Mostard, Guy J.M.
AU - van Twist, Daan J.L.
N1 - Funding Information:
The implementation of this regionwide DVT care pathway was a collaborate effort. The authors therefore would like to thank all GPs and the Department of Medical Imaging of Zuyderland Medical Center for their efforts. The authors also gratefully acknowledge the team of the outpatient DVT clinic for their assistance and collaboration. This study was partially funded by Bayer AG as an investigator-initiated study. The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.
Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/8/1
Y1 - 2024/8/1
N2 - Background: Patients with suspected deep vein thrombosis (DVT) are typically referred to the emergency department for immediate evaluation. To enhance efficiency, our hospital implemented a regional, general practitioner (GP)-driven DVT care pathway, deferring diagnostic evaluation to a scheduled outpatient DVT clinic appointment the following day. Patients receive a single dose anticoagulant from their GP to prevent thrombosis progression while awaiting diagnostic workup. This prospective study aimed to evaluate the safety and patient preferences regarding the DVT care pathway and the type of single dose anticoagulant (low-molecular-weight heparin (LMWH) vs. direct oral anticoagulant (DOAC)). Methods: Patients enrolled in the DVT care pathway between June 2021 and July 2023 were eligible. Until July 2022, LMWH was administered, and thereafter, the protocol recommended DOAC as the single dose anticoagulant. Patients completed questionnaires, incorporating patient-reported outcome and experience measures (PROMs/PREMs), during their DVT clinic visit and after five days. The primary endpoint was bleeding events within 72 h of receiving the single dose anticoagulant. Results: Of 460 included patients, 229 received LMWH and 231 received DOAC as the single dose anticoagulant. DVT was confirmed in 24.8 % of patients. No major or clinically relevant non-major bleeding were reported. LMWH was associated with more minor bleedings (22.3 % vs. DOAC 13.4 %), primarily attributed to injection site hematomas. Patients reported high satisfaction with the DVT care pathway (96.5 %) and generally preferred DOAC over LMWH. Conclusion: Deferring diagnostic evaluation for DVT using a single dose of either LMWH or DOAC in a real-world population is deemed safe. Considering practical advantages, patient preferences, and fewer skin hematomas, we favor DOACs as the single dose anticoagulant in this care pathway.
AB - Background: Patients with suspected deep vein thrombosis (DVT) are typically referred to the emergency department for immediate evaluation. To enhance efficiency, our hospital implemented a regional, general practitioner (GP)-driven DVT care pathway, deferring diagnostic evaluation to a scheduled outpatient DVT clinic appointment the following day. Patients receive a single dose anticoagulant from their GP to prevent thrombosis progression while awaiting diagnostic workup. This prospective study aimed to evaluate the safety and patient preferences regarding the DVT care pathway and the type of single dose anticoagulant (low-molecular-weight heparin (LMWH) vs. direct oral anticoagulant (DOAC)). Methods: Patients enrolled in the DVT care pathway between June 2021 and July 2023 were eligible. Until July 2022, LMWH was administered, and thereafter, the protocol recommended DOAC as the single dose anticoagulant. Patients completed questionnaires, incorporating patient-reported outcome and experience measures (PROMs/PREMs), during their DVT clinic visit and after five days. The primary endpoint was bleeding events within 72 h of receiving the single dose anticoagulant. Results: Of 460 included patients, 229 received LMWH and 231 received DOAC as the single dose anticoagulant. DVT was confirmed in 24.8 % of patients. No major or clinically relevant non-major bleeding were reported. LMWH was associated with more minor bleedings (22.3 % vs. DOAC 13.4 %), primarily attributed to injection site hematomas. Patients reported high satisfaction with the DVT care pathway (96.5 %) and generally preferred DOAC over LMWH. Conclusion: Deferring diagnostic evaluation for DVT using a single dose of either LMWH or DOAC in a real-world population is deemed safe. Considering practical advantages, patient preferences, and fewer skin hematomas, we favor DOACs as the single dose anticoagulant in this care pathway.
KW - Anticoagulants
KW - Deep vein thrombosis
KW - Diagnosis
U2 - 10.1016/j.thromres.2024.109059
DO - 10.1016/j.thromres.2024.109059
M3 - Article
SN - 0049-3848
VL - 240
JO - Thrombosis Research
JF - Thrombosis Research
M1 - 109059
ER -