ABSTRACT
Cassius Iyad Ochoa Chaar, MD, MS
Associate Professor in Vascular Surgery
Yale University School of Medicine
New Haven, Connecticut, United States
Venous thromboembolism (VTE) is a global disease with significant morbidity and mortality. However, variations in presentation and management of VTE between different continents have not been studied. This project compares presenting symptoms and treatment modalities of patients with VTE in 3 continents: Europe, America, and Asia.
Methods:
The data from the Registro Informatizado de la Enfermedad ThromboEmbólica (RIETE) registry (2011-2021) was reviewed. RIETE is the largest international registry dedicated to VTE that started in Spain and expanded worldwide. Patient characteristics and treatments were compared between Europe, America, and Asia.
Results:
There was a total of 58,865 patients with VTE with the majority from Europe (90.3%) followed by Asia (6.3%) and America (3.4%). Patients diagnosed with VTE in America were significantly younger than the other continents. VTE patients in Asia and America were significantly more racially diverse and more likely to be females compared to Europe. Patients in Asia had the highest likelihood of having diabetes, coronary artery disease, ischemic stroke, and dialysis. Interestingly, patients in Asia were also much more likely to be diagnosed with anemia or have recent major bleeding and had lower mean hemoglobin level on presentation compared to patients in the 2 other continents. Cancer-related VTE was significantly higher in patients from Asia while provoked VTE after surgery or travel was significantly more likely in patients from America. (Table 1) The majority of patients (99%) in all continents were treated with anticoagulation. However, patients treated in America for VTE were significantly more likely to be treated as outpatients and receive a direct oral anticoagulant (DOAC) for initiation and maintenance of therapy (17% and 37%, respectively). The choices of long-term anticoagulants were strikingly different with patients in Europe more likely to receive vitamin K antagonists while patients in Asia receive low molecular weight heparin. Interventions for DVT in the form of mechanical thrombolysis or IVC filter placement were more likely to be used in America. Also, patients in America were more likely to undergo open pulmonary embolectomy. (Table 2)
Conclusions:
There is wide intercontinental variation in VTE presentation and management. Future analysis should evaluate the relationship of these variations with clinical outcomes. Comparative research using a global registry could shed light on VTE biology and treatment.