OC 44.5 - Direct Oral Anticoagulant versus Low-Molecular-Weight Heparin as a Single Dose Anticoagulant for Deferring Diagnostic Evaluation of Suspected Deep Vein Thrombosis

Monday, June 24, 2024

15:45 – 16:00 ICT

Room: Ballroom B4

Presenting Author(s)

Inge H.Y Luu, MD

Zuyderland Medical Center, The Netherlands
Heerlen, Limburg, Netherlands

Co-Author(s)

YA

Yael Appelboom

MD
Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
JW

Jeresa I.A. Willems

MD
Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
RG

Robbert-Jan C.A.M. Gielen

MD
Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
ML

Marc B.I. Lobbes

MD, PhD
Department of Medical Imaging, Zuyderland Medical Center Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
KK

Kemal Külcü

MD
Department of Medical Imaging, Zuyderland Medical Center Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
Hugo ten Cate, MD, PHD

MD, PhD
Departments of Internal Medicine and Biochemistry, Maastricht University Medical Center+, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
JP

Jos Peeters

MD
General practice Overhoven-Hoogveld, Huisartsen Coöperatie Westelijke Mijnstreek, Sittard, The Netherlands
Sittard, Limburg, Netherlands
JP

Jan Palmen

MD
General practice Aarveld Medical Center, Huisartsen Oostelijk Zuid-Limburg, Heerlen, The Netherlands
Sittard, Limburg, Netherlands
JB

Jacqueline Buijs

MD, PhD
Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
KJ

Kon-Siong G. Jie

MD, PhD
Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
Rv

Roel J.W. van Kampen

MD, PhD
Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
GM

Guy J.M. Mostard

MD
Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
Heerlen, Limburg, Netherlands
Dv

Daan J.L. van Twist

MD, PhD
Department of Internal Medicine, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
Sittard, Limburg, Netherlands

Background: Timely diagnosis and treatment of deep vein thrombosis (DVT) are essential to prevent life-threatening complications, often necessitating immediate referral to the emergency department. In an effort to enhance efficiency, our hospital implemented a regionwide, general practitioner (GP)-driven DVT care pathway (Figure 1). In this approach, diagnostic evaluation is deferred to a scheduled appointment at our outpatient DVT-clinic on the following day, with patients receiving a single-dose anticoagulant from their GP to prevent thrombosis progression while awaiting DVT-workup.

Aims: Prospective evaluation of safety and patient preferences regarding 1) the DVT care pathway, and 2) the type of single-dose anticoagulant (low-molecular-weight heparin (LMWH) versus direct oral anticoagulant (DOAC)).

Methods: Patients with suspected DVT, enrolled in the DVT care pathway between June 2021 and July 2023, were eligible for participation. Until July 2022 LMWH was used, and thereafter, the protocol recommended DOAC as the single-dose anticoagulant. Participants completed a questionnaire, incorporating patient-reported outcome and experience measures (PROMs/PREMs), during their DVT-clinic visit and after five days. The primary endpoint was bleeding events within 72 hours of receiving the single-dose anticoagulant. The study was approved by the local ethics committee and all patients provided informed consent.

Results: Of 460 included patients, 229 received LMWH and 231 received DOAC as the single-dose anticoagulant. DVT was confirmed in 24.8% of patients. No major or clinically relevant non-major bleeding were reported (Table 1). LMWH was associated with more minor bleedings (22.3% vs. DOAC 13.4%, p=0.013), primarily attributed to injection site hematomas. Patients reported high satisfaction regarding the DVT care pathway (96.5%) and generally preferred DOAC over LMWH as the single-dose anticoagulant.

Conclusion(s): Deferring diagnostic evaluation for DVT using a single-dose of either LMWH or DOAC in a real-world population is deemed safe. Considering practical advantages, patient preferences, and fewer skin hematomas, we favor DOACs as the single-dose anticoagulant in this care pathway.