Secondary prophylaxis decision‐making in venous thromboembolism: interviews on clinical practice in thirteen countries

ESSENTIALS: Thrombosis experts still struggle to reach consensus regarding the optimal type, dosage and duration of treatment. We asked 13 leaders in the field to comment on the prevention of venous thromboembolism (VTE) in their respective countries. Universally relevant risk factors as well as area‐specific barriers to adequate treatment are identified. Local guidelines may be beneficial to guide decision‐making in areas where universal guidelines fall short. OBJECTIVES: Secondary prevention of venous thromboembolism (VTE) remains a topical and contentious point of debate for thrombosis experts around the globe. This discussion centers around two aspects: optimum treatment duration and which type and dosage of thromboprophylaxis to prescribe. Collectives of thrombosis experts have tried to steer the debate by issuing periodical best‐practice guidelines. However, the lack of adherence to said guidelines is such that there is a growing body of research devoted to this very problem. Most of the studies on the subject retrospectively observe a single setting, which leaves important questions as to the generalizability of their findings. As each setting appears to face its own unique challenges, the overarching question of why there is so much variance between physicians when it comes to the secondary prevention of VTE is never fully addressed. METHODS: For this study, we asked thirteen senior‐level physicians representing equally as many countries about the current state of clinical practice regarding the secondary prevention of VTE. RESULTS: The discussion identifies several barriers to adequate VTE prevention, and hints at area‐specific idiosyncrasies that may explain why physicians from different locales treat VTE patients differently. CONCLUSION: Universal treatment guidelines may not fully translate to clinical practice in many areas, and that promoting local guidelines to supplement the universal guidelines may be beneficial.