The Real-World Treatment Status of Venous Thromboembolism in Underdeveloped Areas of Southwestern China

Background: Little is known about the current management status of venous thromboembolism (VTE) in the underdeveloped areas of China, where it is the third most frequent cardiovascular disease. We aimed to investigate the status of anticoagulant use of VTE in southwestern China and assess the related factors of deep venous thrombosis (DVT)-complicated pulmonary embolism (PE). Methods: We extracted data from YiduCloud database from July 1999 to November 2018 and performed a cross-sectional survey including 36,812,353 medical records in seven medical centers. Demographics and laboratory tests were collected and analyzed. Findings: A total of 7353 patients with VTE (mean age 64·3±17·5 years) were included in the study and were divided into the DVT group (only DVT), PE group (only PE), and DVT-PE group (DVT complicated PE). A total of 4579 (62·3%) patients were given traditional anticoagulants, and only 6·5% reached the international normalized ratio (INR) therapeutic levels (2·0-3·0). Only 510 (6·9%) patients were treated with novel oral anticoagulants (NOACs), and 2264 (30·8%) patients were not administered any anticoagulants. Patients in the DVT-PE group (10·9%) used NOACs more than those in the DVT group (8·8%). Moreover, logistic analysis demonstrated that older patients who were male and had higher INR, lipoprotein a, alanine aminotransferase (ALT) and direct bilirubin (DBIL) had higher risk of complicated PE. Interpretation: Nearly one-third of the VTE patients did not receive any anticoagulant therapies, and NOACs were insufficiently used. Even in patients under traditional anticoagulants, INR was poorly controlled. Chinese doctors need to administrate the optimal anticoagulation therapy for patients with DVT. Funding Statement: This work was supported by the National Natural Science Foundation of China (grant numbers 81170188 and 30971212), the Natural Science Foundation of Chongqing (grant number CSCT 2009BB5069), and the Chongqing Municipal Health and Family Planning Commission (grant numbers 2016HBRC001 and 2016XMSB 0003767). Declaration of Interests: The authors declare that there is no conflict of interest. Ethics Approval Statement: The Human Research Committee of Chongqing Medical University approved this study and waived the need for informed consent. Participants were enrolled if the patients were diagnosed with DVT or/and PE and if they ever received treatment in the seven medical centers. A total of 7353 patients with VTE were included in the study and were divided into the DVT group (only DVT), PE group (only PE), and DVT-PE group (DVT complicated PE).