Clinical practice patterns in the identification, diagnosis, and management of venous thromboembolism: An observational, physician-based survey in India with the expert panel opinion

Abstract

Background: We conducted a physician-based survey to understand the management and clinical practicing patterns of venous thromboembolism (VTE) by physicians in India. Methods: This was an observational, physician-based clinical survey. A set of 22 questions on diagnosis, prophylaxis, duration of treatment, and risk factors of VTE was formulated along with nine patient case-studies. Seventy-six consulting physicians across India responded to the survey questionnaire. An expert panel comprising vascular surgeon, cardiac surgeon, and senior physicians provided recommendations on the recorded survey responses. Results: About 63.16% of physicians considered clinical examination of VTE based on signs and symptoms, whereas 23.68% used deep-vein thrombosis (DVT) scores (Wells score) to assess patients' risk. Recent surgery was considered a risk factor for developing DVT or pulmonary embolism by 86.84% of physicians; 82.89% preferred performing duplex ultrasonography test, and on positive results, treated patients for DVT. Dabigatran was the preferred choice of treatment by the participants. VTE prophylaxis with oral anticoagulants was considered by 80.3% of physicians during major orthopedic surgery. Direct oral anticoagulant (DOAC) with bridging therapy was preferred by 44.74% of physicians and 77.63% felt that DOACs will lead to a better quality of life for VTE patients. For patients with permanent risk factors of DVT, 76.32% of physicians preferred the indefinite duration of anticoagulation therapy. Conclusions: VTE remains a growing area of concern that needs to be managed in line with the clinical guidelines. These insights may aid in developing strategies for diagnostic accuracy and treatment of DVT.

Keywords

• anticoagulants
• d-dimer
• deep vein thrombosis
• direct oral anticoagulants