Telemedicine-Based Specialized Care Improves the Outcome of Anticoagulated Individuals with Venous Thromboembolism—Results from the thrombEVAL Study

Keller, Karsten; Göbel, Sebastian; Cate, Vincent ten; Panova‐Noeva, Marina; Eggebrecht, Lisa; Nagler, Markus; Coldewey, Meike; Foebel, Maike; Bickel, Christoph; Lauterbach, Michael; Espinola‐Klein, Christine; Lackner, Karl J.; Cate, Hugo Ten; Münzel, Thomas; Wild, Philipp S.; Prochaska, Jürgen H.

doi:10.3390/jcm9103281

Cited by 5 publications

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“…The thrombEVAL study (registered at: , unique identifier: NCT01809015, accessed on 12 March 2013) was designed as an observational study to compare the quality of oral anticoagulation with vitamin K antagonist treatment (VKA) between patients treated in general medical care and those treated by a specialized telemedicine-based coagulation service [ 32 , 33 , 34 , 35 ]. For the current analysis, all individuals with a history of DVT were analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…Patients ≥ 18 years of age with an indication for VKA were eligible for participation in this observational study. All of the participants provided written informed consent prior to study enrolment [ 35 ]. Inclusion and exclusion criteria are shown in Table S1 in the Supplementary Material .…”

Section: Methodsmentioning

confidence: 99%

“…The following supporting information can be downloaded at: , Figure S1: Work flow of the telemedicine-based coagulation service [ 32 , 33 , 34 , 35 ]; Table S1: Inclusion and exclusion criteria of the thrombEVAL study [ 35 ]; Figure S2: A. Cardiovascular risk factors as independent predictors for isolated PE (without concomitant DVT) in multivari-able logistic regression models vs. patients with isolated DVT (without concomitant PE as the reference group): the model contained the following variables: sex, age, diabetes mellitus, obesity, hypertension, dyslipidemia, family history of myocardial infarction or stroke and smoking. B. Multivariable logistic regression models were used to evaluate the association with isolated PE (without concomitant DVT) (i.e., the dependent variable; reference: isolated DVT without concomitant PE).…”

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confidence: 99%

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Atherosclerosis and Its Impact on the Outcomes of Patients with Deep Venous Thrombosis

Keller

Prochaska

Coldewey

et al. 2022

Life

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Introduction: Atherosclerosis and pulmonary embolism (PE) affect cardiovascular mortality substantially. We aimed to investigate the impact of atherosclerosis on the outcomes of patients with deep venous thrombosis (DVT) and to identify the differences in DVT patients with and without PE. Methods: Patients with DVT with and without symptomatic atherosclerosis (defined as coronary artery disease, myocardial infarction and/or peripheral artery disease) as well as with and without PE under oral anticoagulation were enrolled during January 2011–April 2013 and compared. The impact of symptomatic atherosclerosis on several outcomes was analyzed. Results: Overall, 509 DVT patients (70.0 [56.0–77.0] years, 51.9% females) were included in this study. Among them, 179 (36.3%) had symptomatic atherosclerosis and 204 (40.1%) a concomitant PE. DVT patients with symptomatic atherosclerosis were older (74.0 [IQR 65.0–80.0] vs. 63.0 [48.0–75.0] years, p < 0.0001), more often male (56.4% vs. 43.9%, p = 0.0087) and had a higher prevalence of classical CVRF and a higher Charlson comorbidity index (7.00 [5.00–8.00] vs. 4.00 [2.00–6.00], p < 0.001). Symptomatic atherosclerosis was associated with increased mortality (HR 1.98 [95%CI 1.12–3.49], p = 0.018) and hospitalizations (HR 1.64 [95%CI 1.21–2.21], p = 0.0012 and primary long-term outcome (HR 1.99 [95%CI 1.31–3.04], p = 0.0013) during the 2 years follow-up-period in DVT patients. DVT patients without PE had diabetes mellitus (28.2% vs. 16.3%, p < 0.01) and symptomatic atherosclerosis (42.9% vs. 26.4%, p < 0.001) more often compared to DVT patients with PE, and symptomatic atherosclerosis was associated with isolated DVT (without PE) (OR 2.01 [95%CI 1.28–3.16], p < 0.01). Conclusions: Atherosclerosis was associated with isolated DVT (without PE) and increased mortality in DVT patients under oral anticoagulation. The profile of CVRF and comorbidities differed between DVT patients with and without a concomitant PE. In the case of DVT or PE, patients should be screened for concomitant atherosclerotic disease. Clinical Trial Registration: at clinicaltrials with Unique identifier NCT01809015.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Atherosclerosis and Its Impact on the Outcomes of Patients with Deep Venous Thrombosis

Keller

Prochaska

Coldewey

et al. 2022

Life

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“…The quality of vitamin K antagonist (VKA) management in the clinic is usually measured and reported using 'Time in Therapeutic Range' (TTR) [3]. Patients with shorter TTR are more likely to experience adverse cardiovascular events such as venous thromboembolism (VTE) and hemorrhage [4].…”

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Pharmacogenetics of warfarin dosing in Chinese Adults with nonvalvular atrial fibrillation

Zhu¹,

You²,

Slater

et al. 2022

Preprint

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Background We aimed to evaluate whether genotype-guided warfarin dosing is superior to conventional clinical dosing for the outcomes of interest in Chinese patients. Methods - All patients with nonvalvular AF were randomly divided into two groups, genetic group and control group. We included genotypes for CYP2C9 and VKORC1 in the gene group，then doctors and pharmacists used the warfarin dosing algorithm and clinical information to determine patients’ initial dose, while in control group doses were determined by experince. The international normalized ratio (INR) measurement and standard protocols were used for further dose adjustment in both groups. The primary outcome measure was the percentage of time in the therapeutic range (%TTR) of the INR during follow up after initiation of warfarin treatment. Results The average TTR was (68.36 ± 20.57) % vs (48.52 ± 21.56) %, P<0.001) in the gene group compared with the control group. At the end of follow-up, the genetic group had a significant lower risk of cumulative incidences of ischemic stroke events in the adjusted model [relative risk (RR) 0.38 (95% CI 0.18 to 0.80), log-rank test P =0.008] than control group. There was no significant difference in the risk ratios (RR) for cumulative incidence of total bleeding events, minor bleeding events, gastrointestinal bleeding and intracerebral bleeding events between the two groups(P>0.05). Conclusion Genotype-guided dosing could improve the average TTR, improve the safety of treatment, achieve a higher level of TTR in the early anticoagulation period and reduce the risk of ischemic stroke

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Adherence to guidelines in curative treatment of venous thromboembolism in cancer patients: Insights from a retrospective Tunisian study

Fendri,

Latrous,

Meddeb

et al. 2024

Asia-Pac J Clncl Oncology

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AimTo describe the management and treatment practices of venous thromboembolism (VTE) in cancer patients, assess compliance with the 2023 European Society for Medical Oncology recommendations, and identify factors that may limit or influence their application.MethodsWe conducted, in a Tunisian center, a retrospective study that included patients treated for cancer or hematologic malignancies and diagnosed with deep vein thrombosis (DVT) and/or pulmonary embolism between January 1, 2022, and August 1, 2023.ResultsThe study involved 90 patients. DVTs were significantly predominant (81.1%). VTE mostly occurred within 3 months of the cancer diagnosis (41.1%). All patients received anticoagulant treatment. The most frequently prescribed class of anticoagulants was direct oral anticoagulants (42.2%), followed by low molecular weight heparin (36.7%), and finally vitamin K antagonists (21.1%). Financial constraints and/or refusal of social security to provide the treatment were the main cause for changes in the anticoagulant therapy (16.7%). Deaths (25.5%) and repermeabilization of the initially thrombosed venous network on imaging (11.1%) were the two primary reasons for treatment discontinuation. Bleeding complication was the cause of treatment modification or discontinuation in 7.7% and 5.5% of patients, respectively. Overall, guidelines were fully followed in 49 patients (54.4%) concerning the choice of pharmacological class, dose and duration of treatment. Financial constraints experienced by patients were significantly and independently associated with lower adherence to recommendations (p = 0.032).ConclusionAdherence to guidelines is insufficient. Measures must be implemented to enhance the management of VTE and to develop strategies for improving access to anticoagulants.

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Telemedicine-Based Specialized Care Improves the Outcome of Anticoagulated Individuals with Venous Thromboembolism—Results from the thrombEVAL Study

Cited by 5 publications

References 50 publications

Atherosclerosis and Its Impact on the Outcomes of Patients with Deep Venous Thrombosis

Atherosclerosis and Its Impact on the Outcomes of Patients with Deep Venous Thrombosis

Pharmacogenetics of warfarin dosing in Chinese Adults with nonvalvular atrial fibrillation

Adherence to guidelines in curative treatment of venous thromboembolism in cancer patients: Insights from a retrospective Tunisian study

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