Management of venous thromboembolic disease in ambulatory and hospital,settings:: an assessment of general practices in France

Objective : In spite of increasing use of prophylactic treatments. venous thromboembolic disease (VTD) remains an important public health problem because of its high morbidity and mortality. in particular after major orthopedic Surgery. The aim of this study is to provide an assessment of current medical management of VTD and post-thrombotic disease (PTD) in France. Method : A random sample of 2 10 investigators including hospital practitioners (orthopedic surgeons and anesthesiologists), general practitioners (GP), and angiologists working in the ambulatory setting completed a standardized questionnaire about their current medical practice. Results : VTD led to an additional 8.5 days of hospital stay needed for the management of deep vein thrombosis (DVT) and 15.8 days in the event of pulmonary embolism (PE). Doppler diagnosis of DVT was obtained in 97% to 100% of patients. When PE was suspected, a lung scan was performed in 62% of patients managed by hospital practitioners and in 43% of patients treated by GPs. Whereas the rate of hospitalization for distal DVT diagnosed in outpatients did not exceed 14% of patients, the rate of hospitalization for proximal DVT reached 40% - 48%. Eighty-eight percent of the patients with PE were managed in a hospital setting. Two-thirds of the patients with PE were given low-molecular-weight heparin for an average duration of 9.3 days and one-third of patients were treated with non-fractioned heparin for an average duration of a 11 days. Doppler diagnosis of PTD was established in 98% of patients and 98% of the patients with PTD were treated with elastic contention stockings. Conclusion : Based on physicians' report of their current medical practice, this Study provides useful data on diagnostic and therapeutic practices in the management of VTD and PTD.