Explore the latest advancements in the treatment of Venous Thromboembolism (VTE) in the Emergency Department, particularly in the era of Direct Oral Anticoagulants (DOACs). This blog post delves into the significance of these treatments, their impact on patient outcomes, and how they are revolutionizing emergency medicine.
– by James
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The Treatment of Venous Thromboembolism in the Emergency Department in the DOACs Era.
Osman et al., Isr Med Assoc J 2023
PMID: 37980618
This retrospective cohort study aimed to understand the treatment and discharge protocols for newly diagnosed venous thromboembolism (VTE) patients in Israel. The study included 443 patients, with 89% diagnosed with deep vein thrombosis (DVT). Key findings include:
- Approximately 75% were treated with anticoagulants in the emergency department (ED), with 98% receiving enoxaparin.
- At discharge, all patients were recommended anticoagulants; 49% continued with enoxaparin, 47% with direct oral anticoagulants (DOACs), and 4% with warfarin.
- After 4 weeks, 67% were treated with DOACs, 22% with enoxaparin, and 5% with warfarin. Around 6% discontinued all treatment.
- After 12 weeks, 90% of the patients on DOACs adhered to the protocol, compared to 70% and 50% among enoxaparin and warfarin users, respectively.
- Only 56% were referred for hematological evaluation.
- The 12-week rate of adverse reactions was approximately 2%.
The study suggests that clinician training regarding the discharge of VTE patients from the ED should continue. The use of DOACs and the recommendation for further hematological evaluation increased over time.