Evolución del manejo clínico de pacientes diagnosticados de trombosis venosa profunda aguda sintomática: 2001 a 2014

Resumen

Background: A comprehensive evaluation of temporal trends in the treatment of patients who have deep vein thrombosis (DVT) may assist with identification of modifiable factors that contribute to short-term outcomes. Methods: We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies among 26,695 adults with DVT enrolled in the RIETE registry between 2001 and 2014. We also examined temporal trends in risk-adjusted rates of all-cause, PE-related, and bleedingrelated death to 30-days after diagnosis. Results: The mean length of hospital stay decreased from 9.0 days in 2001- 2005 to 7.6 days in 2010-2014 (P <0.01). For initial DVT treatment, the use of low-molecular weight-heparin decreased from 98% to 90% (P <0.01). Direct oral anticoagulants use increased from 0.5% in 2010 to 13.4% in 2014 (P <0.001). Risk-adjusted rates of 30-day all-cause mortality decreased from 3.9% in 2001-2005 to 2.7% in 2010-2014 (adjusted rate ratio per year, 0.84; 95% confidence interval [CI], 0.74 to 0.96; P <0.01). VTE-related mortality showed a non-statistically significant downward trend (adjusted rate ratio per year, 0.70; 95% CI, 0.44 to 1.10; P =0.13), whereas 30-day bleeding-related mortality significantly decreased from 0.5% in 2001-2005 to 0.1% in 2010- 2014 (adjusted rate ratio per year, 0.55; 95% CI, 0.40 to 0.77; P <0.01). Conclusions: This international registry-based temporal analysis identified reductions in length of stay for adults hospitalized for DVT. The study also found a decreasing trend in adjusted rates of all-cause and bleeding-related mortality.