Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares: A clinical practice survey

•In France GP and VMP treat distal and proximal DVT with full dose of anticoagulants•Most GP consider that distal and proximal DVT exhibit the same risks•Half of GP do not modulate duration of anticoagulation therapy of DVT•Systematic referral to a thrombosis expert seems appropriate to improve management

IntroductionDistal deep-vein thromboses (iDDVT) are infra-popliteal DVTs. They are as frequent but less serious than proximal DVT. Their management is debated.MethodsClinical practice survey among a random selection of 111 general practitioners (GP) and 56 vascular medicine physicians (VMP) working in Languedoc-Roussillon (France) to assess and compare iDDVTs management by GP and VMP.ResultsIn case of DVT, GP manage their patients alone in 35% of cases. In case of collaborative management, VMP initiate and stop anticoagulants (> 74% of cases) whereas GP monitor anticoagulation (> 76% of cases). With iDDVT, there was no difference between GP and VMP in terms of use (94% vs. 92%) and intensity of anticoagulation (full dose: 99%vs.100%). Duration of anticoagulation differed: GP modulated less frequently duration of anticoagulation in presence of a transient risk factor (58% vs. 90%, p < 0.05) or according to the deep-calf or muscular location of iDDVT (6% vs. 36%, p < 0.05) and treated more frequently iDDVT as long as proximal DVT (49% vs. 13%, p < 0.05). When comparing GP, there was no significant difference in terms of therapeutic management between those who used to manage DVT alone and those who used to manage in collaboration with a thrombosis expert.ConclusionTreatment of iDDVT differed between GP and VMP. Half of GP don’t modulate treatment according to anatomical location or to the provoked/unprovoked character of DVT. Given the low frequency of exposure to DVT in general practice, systematic referral to a thrombosis expert rather than continuous medical formation program seems appropriate to improve management.