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Thromb Haemost 2022; 122(04): 600-610
DOI: 10.1055/a-1535-8726
Stroke, Systemic or Venous Thromboembolism

Deciding on Treatment Duration for Unprovoked Venous Thromboembolism: What is Important to Patients?

Anouk van de Brug‡   *
1   Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
2   Department of Internal Medicine, St Jansdal Hospital, Harderwijk, The Netherlands
,
Maria A. de Winter‡   *
1   Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
,
Marije ten Wolde
3   Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
,
Karin Kaasjager
1   Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
,
Mathilde Nijkeuter
1   Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
› Author Affiliations Funding None.
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Abstract

Background After 3 months of anticoagulation for unprovoked venous thromboembolism (VTE), a decision must be made to stop or continue indefinitely by weighing risks of recurrence and bleeding through shared decision-making (SDM). Despite the importance of patient involvement, patients' perspectives on treatment duration are understudied.

Aim To describe the knowledge of VTE and anticoagulation, need for education, perception of risks and benefits of extended treatment, and factors influencing patient's preference to stop or continue treatment after unprovoked VTE.

Methods Semistructured interviews were conducted between May 2019 and August 2020 with adults with unprovoked VTE in one university hospital and one general hospital. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using conventional content analysis.

Results Eighteen patients were interviewed (median age 64, range: 32–83 years). Three major themes were identified: diagnosis and initial treatment, SDM, and perception of treatment. Education, knowledge, coping, and attitude toward health care suffused major themes. The impact of VTE on daily life varied between individuals, as did the preferred extent of SDM. Overall, patients who felt involved and informed were more satisfied with received care, more aware of risks and benefits of treatment, and more likely to be treatment adherent. Generally, patients were more concerned with risk of recurrent VTE than with risk of bleeding during anticoagulation. We identified a multitude of aspects important to patients when deciding to stop or continue anticoagulation.

Conclusion Sufficient information and an individualized extent of SDM are of crucial importance for patients when deciding on treatment duration after unprovoked VTE.

Keywords

deep venous thrombosis - pulmonary embolism - qualitative research - anticoagulation - shared decision-making

Authors' Contributions

A.v.d.B., M.A.d.W., M.N., and H.A.H.K. designed the study protocol. A.v.d.B. and M.A.d.W. conducted the interviews, analyzed the data, and drafted the manuscript. M.N. and M.t.W. were responsible for patient inclusion. All authors critically revised the manuscript, were responsible for and approved its final version.


* Authors contributed equally.


Supplementary Material



Publication History

Received: 13 April 2021

Accepted: 22 June 2021

Accepted Manuscript online:
24 June 2021

Article published online:
05 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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