Prescribing patterns of antithrombotic therapy for lower extremity endovascular procedures and venous thromboembolism management in mainland China

Objective The use of antithrombotic agents in vascular disease was a common clinical practice despite a lack of clear convincing evidence. The goal of this study was to explore prescribing patterns of antithrombotic drugs among vascular surgeons in China. Methods Attendees at a national vascular surgery meeting (CEC2012 with an attendance of 1453 vascular physicians) were asked to complete a voluntary survey indicating their prescribing patterns of antithrombotic drugs in patients undergoing infrainguinal endovascular procedures or suffering venous thromboembolism (VTE). Results A total of 155 valid responses were gathered, of which 80.6% were submitted by vascular surgeons. 93.5% of the responses were from physicians practicing in tertiary hospitals covering 25 provinces in China. For VTE prophylaxis, 80.0% of respondents would prescribe anticoagulation to high-risk nonorthopedic surgical patients. For VTE therapy, 76.1% of responding physicians would utilize extended bed rest strategy, and 77.4% would prescribe anticoagulation, of whom 11.2% would treat the patients for 3 months. The hospitals where the respondents practice had median monthly infrainguinal endovascular procedures of 21 (interquartile 13~ 41) cases. The rates of initial postoperative use of single, dual or triple antithrombotic treatment were 8.4%, 72.3% and 11.7% , respectively. Among the latter two treatments, 39.2% of respondents would ultimately transfer to mono antiplatelet therapy. Finally, 40.3% of respondents would adopt a life-long antithrombotic strategy. Cilostazol (63.4% ) and prostacyclin analogue (61.4% ) were the most commonly used adjunctive drugs prescribed following endovascular procedures. Proactive interventions against smoking cessation, hyperlipidemia and diabetes were offered by 90.2% , 80.5% and 77.3% respondents, respectively. Conclusions For VTE management, antithrombotic agents are chosen properly by most vascular surgeons in China, but the treatment duration is highly variable. Following infrainguinal endovascular procedures, a relative high proportion of combined antithrombotic therapy and low proportion of life-long antithrombotic therapy are prescribed. Key words: Vascular surgery; Antithrombotics; Endovascular surgery; Peripheral arterial disease; Venous thromboembolism