Management of the antiplatelet therapy during the diagnosis of venous thromboembolism disease: A national survey of French general practitioners' compared to the French vascular physicians' management

Abstract

Introduction: Approximately 15% of patients treated by anticoagulant for a venous thromboembolic event are also treated with antiplatelet therapy; and this association increases the risk of bleeding. The aim of this survey was to evaluate general practitioner's management of antiplatelet therapy at the initiation of anticoagulation, and at six months compared to French vascular physicians' management.

Methods: A questionnaire including 4 clinical situations was established and the physicians were asked to detail antiplatelet and anticoagulant therapy management. From September 2017 to December 2017, an e-mail invitation and a reminder were sent to members of the departmental councils who participated; 218 questionnaires were obtained.

Results: Overall, 91.3% of physicians considered that there was an increased risk of bleeding when antiplatelet therapy is associated with anticoagulation. After initiating anticoagulation, 67% of respondents continued antiplatelet therapy, while 30% stopped. Three strategies were used: 49.0% of physicians maintained concomitant antiplatelet therapy with full-dose anticoagulant, both at anticoagulant initiation and at 6 months; 23% of physicians stopped antiplatelet therapy and prescribed full-dose anticoagulant at initiation and at 6 months; 12.4% of physicians prescribed antiplatelet therapy associated with reduced-dose anticoagulation at 6 months regardless of the strategy at anticoagulant initiation.

Conclusion: One third of general practitioners stopped antiplatelet therapy at the initiation of an anticoagulation for a venous thromboembolic event. Prospective controlled trials are needed to clarify the best way to treat these patients in this situation.

Keywords: Anticoagulation; Antiplatelet therapy; Venous thromboembolism disease.