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Poster Networking

Venous Thromboembolism

PB0397 - Long-term anticoagulation management in patients with venous thromboembolism: evaluation of an outpatient clinic led by a nurse practitioner

Sunday, June 23, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall

    Presenting Author(s)

  • Tessa Elling, MD

    PhD-student
    Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
    Groningen, Groningen, Netherlands

    • Co-Author(s)

  • NV

    Nic J.G.M. Veeger

    Clinical epidemiologist, PhD
    Department of Clinical Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    Groningen, Groningen, Netherlands

  • MV

    Marja A.J. Voskuilen

    Nurse practitioner
    Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
    Groningen, Groningen, Netherlands

  • Karina Meijer

    MD, PhD, professor
    Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    Groningen, Groningen, Netherlands

Background: Guidelines recommend systematic follow-up for long-term anticoagulation in venous thromboembolism (VTE) patients to optimize therapy, yet consensus on the optimal approach is lacking. To address this, we evaluated an outpatient clinic at the University Medical Centre of Groningen (UMCG), led by a nurse practitioner.

Aims: To assess the types and frequency of anticoagulation-related interventions at the UMCG outpatient clinic.

Methods: This retrospective cohort study included all patients who had two visits at the outpatient clinic between August 2018 and November 2023. Anticoagulation quality was assessed at each visit, covering the indication, comorbidities, comedication, blood pressure, renal function, time in therapeutic range (TTR), cognitive function and fall risk. Interventions were initiated based on this assessment.

Results: A total of 625 patients were included. During the first visit (55.8% male, mean age 59.5 years), the majority received oral anticoagulation (direct oral anticoagulant (DOAC): 54.9%, vitamin K antagonist (VKA): 43.0%) primarily for recurrent VTE (56.0%), idiopathic VTE (19.5%) or VTE with a persistent risk factor (13.8%).

Interventions occurred in 36.8% of patients, with 12.3% pharmacological (DOAC: 5.2%, VKA: 20.4%) and 27.7% non-pharmacological (DOAC: 26.8%, VKA: 29.4%) (table 1). DOAC patients with non-pharmacological interventions were older, compared to patients without an intervention (mean ± standard deviation: 65.9 ± 12.2 vs. 57.3 ± 15.1). There were no differences in patient characteristics between VKA patients with or without an intervention.

Fewer interventions (25.2%) were observed during subsequent appointments, with 5.3% pharmacological and 21.8% non-pharmacological. An increase in TTR was observed at subsequent visits in patients with an initial TTR below 70%, more pronounced in patients with an intervention (figure 1).

Conclusion(s): Systematic follow-up for patients on long-term anticoagulation is essential, as evidenced by up to 40% of patients requiring interventions. An outpatient clinic led by a nurse practitioner could be a viable option for providing anticoagulation care for these patients.