Current primary care practice in the diagnosis and management of patients with suspected venous thromboembolism and prescription of inibition dose of Enoxaparin

Abstract

Aim. Ambulatory care of patients with deep vein thrombosis (DVT) has been well validated but limited data exist on the diagnostic and therapeutic management of venous thromboembolism (VTE) in primary care. Methods. A cross-sectional survey on the clinical conditions for the initiation of once daily (OD) enoxaparin and on the diagnostic and therapeutic strategy of VTE in ambulatory patients using a single-visit questionnaire to be filled out by the general practitioner (GP). Results. Of the 4522 included patients, 2164 (48%) were started on therapeutic OD enoxaparin for confirmed or suspected proximal DVT, 464 (10%) for distal DVT, 493 (11%) for pulmonary embolism (PE), and 742 (16%) for superficial venous thrombosis (SVT). Further indications included bridging of oral anticoagulation in 173 patients (4%), atrial fibrillation in 77 patients (2%) and prevention VTE in 78 patients (2%). Enoxaparin was initiated on the basis of clinical probability before objective confirmation in 17%, 33%, 53% and 69% of patients with a diagnosis of PE, proximal DVT, distal DVT and SVT, respectively. No objective testing was planned for 3%, 9%, 18% and 41% of patients in these respective categories. Patients were referred to specialist care in 88%, 49%, 42% and 21% of patients with PE, proximal DVT, distal DVT and SVT, respectively. Conclusion. Therapeutic OD enoxaparin is prescribed in primary care for the whole clinical spectrum of VTE. However, the diagnostic work-up is unsatisfactory to suboptimal in a substantial proportion of these patients. [Int Angiol 2010;29:58-63]