Management of venous thromboembolism in France – a nationwide clinical practice survey among vascular medicine specialists

Summary: Background: In routine clinical practice, patient’s management may differ from scientific organizations’ guidelines and compromise patient’s safety. This discrepancy indicates either an educational gap to fill or a need to adapt the guidelines to better reflect the real-world practice. Aims: Describe the management of venous thromboembolism (VTE): deep vein thrombosis (DVT) and pulmonary embolism (PE) among Vascular Medicine Specialists (VMS) practicing in France between 2020 and 2023 and compare it to national and international VTE guidelines. Materials and methods: A random selection of VMS from the national VMS directory were asked to 1) complete a questionnaire on their own management of patients with VTE (VMS survey) and 2) report their personal management of five consecutive patients with acute VTE (VTE case series). The study period partly overlapped with the COVID-19 pandemic, during which outpatient management strategies were increasingly promoted. Results: Among the 163 VMS contacted, 85 agreed to participate. We found that a direct oral anticoagulant (DOAC) was preferentially prescribed as first line anticoagulant in VTE: 65% in the VTE case series and 80% in the VMS survey. Low molecular weight heparins (LMWH) was preferred in case of high-risk PE (60%) or ilio-femoral DVT (35%) and in cancer-associated thrombosis (91%) in the VMS survey. After the first 6 months therapy, 30% of the VMS taper to a reduced-dose DOAC. This management was consistent with the VTE case series. Conclusions: DOAC is the standard of care to treat most VTE conditions in routine clinical practice, in line with VTE guidelines. LMWH is still preferred in case of high risk-PE and cancer-associated thrombosis. ECS use to prevent post-thrombotic syndrome remains frequent after DVT. Outpatient management of PE was common during the study period, reflecting evolving care models that were reinforced during the COVID-19 pandemic.