Rognoni Carla, Lugli Marzia, Maleti Oscar, Tarricone Rosanna
Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy.
National Reference Training Center in Phlebology (NRTCP), Vascular Surgery - Cardiovascular Department, Hesperia Hospital, Modena, Italy.
J Vasc Surg Venous Lymphat Disord. 2021 Sep;9(5):1334-1344.e1. doi: 10.1016/j.jvsv.2021.01.020. Epub 2021 Mar 18.
Deep vein thrombosis (DVT) is one of the major health problems worldwide with potentially serious outcomes related to mortality and morbidity. We provide a current view on how patients with DVT are managed in routine practice compared with the recommendations of published clinical guidelines.
A literature review was conducted on studies reporting diagnostic and treatment patterns for acute DVT. Four dimensions were evaluated to compare the differences between clinical practice and clinical guidelines recommendations: diagnostic pathway, prescription of pharmacologic treatment and related duration, and prescription of compression therapy. For each aspect, the agreement with the corresponding guideline has been estimated as a percentage ranging from 0% (no agreement) to 100% (full agreement).
Sixteen studies reported clinical practices in 10 countries. Among them, Japan showed the highest agreement with guidelines, followed by the UK and Switzerland. Hong Kong showed the highest agreement with diagnosis guidelines, Spain for drug treatment, UK for treatment duration, and France for compression therapy. Conversely, Germany reported a complete disagreement with guidelines for diagnosis, followed by low agreement level by UK and Italy, and Switzerland reported a lower agreement level with prescription of compression therapy.
The implementation of clinical guidelines for the management of patients with DVT varies among countries from strict adherence to a complete lack of adherence. In this context, registries may be a useful tool to analyze clinical practice and produce findings that may be generalizable across populations.
深静脉血栓形成（DVT）是全球主要的健康问题之一，具有与死亡率和发病率相关的潜在严重后果。与已发表的临床指南建议相比，我们对DVT患者在常规实践中的管理方式提供了当前观点。
对报告急性DVT诊断和治疗模式的研究进行了文献综述。评估了四个维度以比较临床实践与临床指南建议之间的差异：诊断途径、药物治疗的处方及相关持续时间，以及压迫治疗的处方。对于每个方面，与相应指南的一致性以0%（无一致性）至100%（完全一致）的百分比进行估计。
16项研究报告了10个国家的临床实践。其中，日本与指南的一致性最高，其次是英国和瑞士。香港在诊断指南方面一致性最高，西班牙在药物治疗方面，英国在治疗持续时间方面，法国在压迫治疗方面。相反，德国报告在诊断方面与指南完全不一致，其次是英国和意大利的低一致性水平，瑞士在压迫治疗处方方面报告的一致性水平较低。
各国在DVT患者管理临床指南的实施方面差异很大，从严格遵守到完全不遵守。在这种情况下，登记处可能是分析临床实践并产生可在人群中推广的结果的有用工具。
