Results:
There was a total of 71 (30%) physician responses of SAPHOS’s 236
subscribers at the time of posting, 65/71 (91.5%) managed patients with
VTE, 60/71 (84.5%) completed the entire survey. Table 1 provides a
summary of the respondent’s demographics. The case description and
responses to management questions are provided in Table 2.
Case 1 described a 4-year-old female child with an incidentally found
asymptomatic CVC-associated upper extremity VTE in the setting of a
critical illness. Only 16.7% of respondents performed a thrombophilia
evaluation. The majority (72%) would initiate anticoagulation, 3% only
used anticoagulation if the thrombophilia testing was abnormal, 20%
only if the repeat US shows propagation of the clot, and 3.3% elected
not to treat.
There was a significant variation in the duration of anticoagulation:
19% treated for 6 weeks, 41.4% for 12 weeks, and 29.3% treated until
the CVC was removed regardless of the duration of therapy.
The patient in case 1 required a follow-up ultrasound a week later,
which demonstrated clot resolution. 35% would continue anticoagulation
at prophylactic dosing for the duration of CVC insertion. 5% would for
continuing anticoagulation at therapeutic dosing, for the duration of
the CVC. 24% used therapeutic dosing for 6 weeks, while 22.4% did so
for 12 weeks. 10.3% elected to stop anticoagulation treatment. Overall,
it seems that clot resolution did not influence the duration of
treatment among the respondents.
The patient in case 1 required subsequent CVC placement 6 months later.
20% of respondents placed her on anticoagulation for secondary
prophylaxis, whereas 21.4% only used secondary prophylaxis if there was
a previously identified thrombophilia. 57% did not start secondary
anticoagulation prophylaxis.