Venous thromboembolism management practices and knowledge of guidelines: a survey of Australian haematologists and respiratory physicians

Abstract

Background: Current international clinical practice guidelines do not adequately address all clinical scenarios in the management of venous thromboembolism (VTE), and no comprehensive Australian guidelines exist. Aims: To identify areas of uncertainty in VTE management and whether self-reported practice is consistent with guidelines. Methods: We conducted an Australian cross-sectional online survey consisting of 53 questions to investigate doctors’ VTE management practices. The survey was distributed to consultant and trainee/registrar haematologists and respiratory physicians with the aid of participating medical societies. Results: A total of 71 haematologists and 110 respiratory physicians responded to the survey. The majority of survey respondents were 31–50-years old and worked in teaching hospitals and in the acute care setting. Under-treatment was reported for high-risk pulmonary embolism (PE) and duration of anticoagulation for first-episode unprovoked PE (32 and 83% respectively). Over-treatment was reported in areas of thrombolysis for intermediate-risk PE (16%) and duration of anticoagulation for first-episode provoked PE (41%). Uncertainty and variations in doctors’ management approaches were also found. Conclusion: This survey demonstrated significant over-treatment, under-treatment and variability in the practice of VTE management. The findings highlight the need for the development and implementation of national guidelines for the management of VTE in Australia.