Citation Information :
Kamerkar DR, John MJ, Desai SC, Dsilva LC, Joglekar SJ. Arrive: A retrospective registry of Indian patients with venous thromboembolism. Indian J Crit Care Med 2016; 20 (3):150-158.
Background and Aim: There is lack of substantial Indian data on venous thromboembolism (VTE). The aim of this study was to provide real-world information on patient characteristics, management strategies, clinical outcomes, and temporal trends in VTE.
Subjects and Methods: Multicentre retrospective registry involving 549 medical records of patients with confirmed diagnosis of VTE (deep vein thrombosis [DVT] confirmed by Doppler ultrasonography; pulmonary embolism [PE] by computed tomography, pulmonary angiography and/or V/Q scan) from 2006 to 2010 at three Indian tertiary care hospitals.
Results: Acute DVT without PE, acute DVT with PE, and PE alone were reported in 64% (352/549), 23% (124/549), and 13% (73/549) patients, respectively. Mean age was 47 (±16) years, and 70% were males. H/o DVT (34%), surgery including orthopedic surgery (28%), trauma (16%), and immobilization >3 days (14%) were the most common risk factors for VTE. Hypertension (25%), diabetes (19%), and neurological disease (other than stroke) (8%) were the most common co-morbidities. Most (94%) were treated with heparin alone (82%) or fondaparinux (2%) for initial anticoagulation; low molecular weight heparin alone (5%) or warfarin/acenocoumarol (76%) for long-term anticoagulation. Anticoagulant treatment was stopped because of bleeding in 2% (9/515) patients. Mortality was 7% among patients diagnosed with VTE during hospital stay versus 1% in those hospitalized with diagnosed VTE. The annual incidence of DVT (±PE) increased from 2006 to 2010.
Conclusion: Acute DVT alone was responsible for the substantial burden of VTE in Indian patients. Bleeding was not the limiting factor for anticoagulant treatment in most patients.
Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756-64.
White RH. The epidemiology of venous thromboembolism. Circulation 2003;107 23 Suppl 1:I4-8.
Kahn SR, Ginsberg JS. The post-thrombotic syndrome: Current knowledge, controversies, and directions for future research. Blood Rev 2002;16:155-65.
Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004;350:2257-64.
Kapoor VK. Venous thromboembolism in India. Natl Med J India 2010;23:193-5.
Cronan JJ, Dorfman GS, Grusmark J. Lower-extremity deep venous thrombosis: Further experience with and refinements of US assessment. Radiology 1988;168:101-7.
Stulberg BN, Insall JN, Williams GW, Ghelman B. Deep-vein thrombosis following total knee replacement. An analysis of six hundred and thirty-eight arthroplasties. J Bone Joint Surg Am 1984;66:194-201.
Lee LH, Gu KQ, Heng D. Deep vein thrombosis is not rare in Asia - The Singapore General Hospital experience. Ann Acad Med Singapore 2002;31:761-4.
Dhillon KS, Askander A, Doraismay S. Postoperative deep-vein thrombosis in Asian patients is not a rarity: A prospective study of 88 patients with no prophylaxis. J Bone Joint Surg Br 1996;78:427-30.
Agarwala S, Bhagwat AS, Modhe J. Deep vein thrombosis in Indian patients undergoing major lower limb surgery. Indian J Surg 2003;65:159-62.
Silverstein MD, Heit JA, Mohr DN, Petterson TM, O′Fallon WM, Melton LJ 3 rd - Trends in the incidence of deep vein thrombosis and pulmonary embolism: A 25-year population-based study. Arch Intern Med 1998;158:585-93.
Kakkar N, Vasishta RK. Pulmonary embolism in medical patients: An autopsy-based study. Clin Appl Thromb Hemost 2008;14:159-67.
Lee AD, Stephen E, Agarwal S, Premkumar P. Venous thrombo-embolism in India. Eur J Vasc Endovasc Surg 2009;37:482-5.
Pinjala R; ENDORSE-India investigators. Venous thromboembolism risk & prophylaxis in the acute hospital care setting (ENDORSE), a multinational cross-sectional study: Results from the Indian subset data. Indian J Med Res 2012;136:60-7.
Pai N, Ghosh K, Shetty S. Cause of deep venous thrombosis and pulmonary embolism in young patients from India as compared with other ethnic groups. Blood Coagul Fibrinolysis 2012;23:257-61.
Samama MM. Epidemiology of risk factors of deep venous thrombosis (DVT) of the lower limbs in community practice: The SIRIUS study. Thromb Haemost 1993;69:763.
Nagi ON, Dhillon MS, Katariya S, Mujeeb SM. Deep vein thrombosis after major surgery-evaluation by compression ultrasonography. Indian J Orthop 1999;33:200-3.
Sharma H, Maini L, Agrawal N, Upadhyay A, Vishwanath J, Dhaon BK. Incidence of deep vein thrombosis in patients with fractures around hip joint: A prospective study. Indian J Orthop 2002;36:5.
Jang MJ, Choi WI, Bang SM, Lee T, Kim YK, Ageno W, et al. Metabolic syndrome is associated with venous thromboembolism in the Korean population. Arterioscler Thromb Vasc Biol 2009;29:311-5.
Dupras D, Bluhm J, Felty C, Hansen C, Johnson T, Lim K, et al. Institute for Clinical Systems Improvement. Venous Thromboembolism Diagnosis and Treatment. Available from: http://www.bit.ly/VTE0113. [Last updated on 2013 Jan].
White RH, Zhou H, Romano PS. Length of hospital stay for treatment of deep venous thrombosis and the incidence of recurrent thromboembolism. Arch Intern Med 1998;158:1005-10.
Levine M, Gent M, Hirsh J, Leclerc J, Anderson D, Weitz J, et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 1996;334:677-81.
Koopman MM, Prandoni P, Piovella F, Ockelford PA, Brandjes DP, van der Meer J, et al. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. N Engl J Med 1996;334:682-7.
Janjua M, Badshah A, Matta F, Danescu LG, Yaekoub AY, Stein PD. Treatment of acute pulmonary embolism as outpatients or following early discharge. A systematic review. Thromb Haemost 2008;100:756-61.
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9 th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141 2 Suppl:e419S-94S.
Nieto JA, Solano R, Ruiz-Ribó MD, Ruiz-Gimenez N, Prandoni P, Kearon C, et al. Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: Findings from the RIETE registry. J Thromb Haemost 2010;8:1216-22.
Spyropoulos AC, Lin J. Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: An administrative claims analysis from 30 managed care organizations. J Manag Care Pharm 2007;13:475-86.
Pandey A, Patni N, Singh M, Guleria R. Assessment of risk and prophylaxis for deep vein thrombosis and pulmonary embolism in medically ill patients during their early days of hospital stay at a tertiary care center in a developing country. Vasc Health Risk Manag 2009;5:643-8.