Abstract

BACKGROUND: Venous thromboembolism (VTE) is a major cause of morbidity and mortality with significant heterogeneity in its management, both within our local practice and in international guidelines. AIMS: To provide a holistic evaluation of 'real-world' Australian experience in the warfarin era, including how we compare to international guidelines. METHODS: Retrospective evaluation of VTE from July 2011 to December 2012 at two major hospitals in Melbourne, Australia. These results were compared to recommendations in the international guidelines. RESULTS: A total of 752 episodes involving 742 patients was identified. Contrary to international guidelines, an unwarranted heritable thrombophilia screen was performed in 22.0% of patients, amounting to a cost of AU$29 000. The duration of anticoagulation was longer compared to international recommendations, although the overall recurrence (3.2/100 person-years) and clinically significant bleeding rates (2.4/100 person-years) were comparable to 'real-world' data. Unprovoked VTE (hazard ratio 2.06; P = 0.01) was a risk factor for recurrence, and there was no difference in recurrence between major VTE (proximal deep vein thrombosis (DVT) and/or pulmonary embolism) and isolated distal DVT (3.02 vs 3.94/100 person-years; P = 0.25). Fourteen patients were subsequently diagnosed with malignancy, and patients with recurrent VTE had increased risk of prospective cancer diagnosis (relative risk 6.68; P < 0.001). CONCLUSIONS: While our 'real-world' VTE experience during the warfarin era largely correlates with international guidelines, there remains heterogeneity in the management strategies, including excessive thrombophilia screening and longer duration of anticoagulation. This audit highlights the need for national VTE guidelines, as well as prospective auditing of VTE management, in the direct oral anticoagulant era for future comparison.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeComparative StudyJournal ArticleMulticenter Study

Indexed MeSH termsAdolescentAdultAgedAged, 80 and overAnticoagulantsData Interpretation, StatisticalDisease ManagementFemaleFollow-Up StudiesHumansInternationalityMale

Summary

Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.

Why This Matters for Hirudotherapy

This retrospective audit of 752 venous thromboembolism episodes at two Melbourne hospitals during the warfarin era found practice largely consistent with international guidelines but flagged excess thrombophilia screening and longer-than-recommended anticoagulation, with unprovoked VTE and recurrence linked to higher recurrence and later cancer diagnosis. Its relevance to hirudotherapy is only as background on how venous thromboembolism is managed and on the anticoagulation context in which leech-derived antithrombotics are situated; the study itself examines warfarin-era clinical management and contains nothing about leeches or the leech secretome. As a caveat, this is a localized real-world audit, not interventional evidence, and it has no bearing on hirudotherapy efficacy or safety; it is included for clinical-context completeness rather than direct support.