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French vascular physicians' practices in indicating antiplatelet and anticoagulation therapy in venous

Antoine Fayol1, Damien Lanéelle2, Clément Hoffmann3

  • 11 Service de Médecine Interne, Hôpital Louis Mourier (Colombes), Assistance Publique - Hôpitaux de Paris (APHP), Université Paris 7, Paris, France.

VASA. Zeitschrift Fur Gefasskrankheiten
|April 5, 2019
PubMed

Insights

French vascular physicians acknowledge increased bleeding risk when combining antiplatelet agents (APA) and anticoagulants for venous thromboembolism (VTE). Management strategies varied significantly among physicians, highlighting the need for comparative trials.

Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Clinical Pharmacy

Background:

  • Widespread antiplatelet therapy (APA) use presents challenges in managing patients requiring anticoagulation for venous thromboembolism (VTE).
  • Combining APA and anticoagulants increases bleeding risk by 1.5-2.5 fold.
  • Current management strategies for this dual therapy in VTE patients are not standardized.

Purpose of the Study:

  • To evaluate the management practices of French vascular physicians regarding the combined use of APA and anticoagulants in VTE patients.
  • To assess physician approaches at both the initiation of treatment and at the 6-month follow-up point.

Main Methods:

  • A survey was conducted among French vascular physicians between September and December 2017.
  • The survey utilized fictional scenarios and isolated questions presented via an online questionnaire.
  • 179 valid responses were collected from 1812 physicians, yielding a 9.9% response rate.

Main Results:

  • 97.2% of physicians recognized the elevated bleeding risk associated with combined APA and anticoagulant therapy.
  • 63% of respondents discontinued APA upon initiating anticoagulation, while 36% did not.
  • Four distinct management strategies were identified, with variations in anticoagulant dosage and APA continuation at 6 months.

Conclusions:

  • French vascular physicians employ diverse treatment strategies based on perceived risk-benefit ratios.
  • Significant heterogeneity exists in clinical practice for managing VTE patients on dual antiplatelet and anticoagulant therapy.
  • Further randomized controlled trials are necessary to establish evidence-based recommendations for optimal management.

Keywords:
anticoagulationantiplatelet therapyvenous thromboembolism disease

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