VERITY Steering Committee Venous Thromboembolism Registry Second Annual Report 2004

Contents Database Overview - Dr Denise O’Shaughnessy –Risk factors in VTERisk factors in VTE –Process of VTE diagnosisProcess of VTE diagnosis –Treatment of VTETreatment of VTE –Outcome dataOutcome data Pulmonary embolism - Dr Nicholas Scriven –Risk factors in PERisk factors in PE –Symptoms in patients with PESymptoms in patients with PE –Investigations in patients with a primary diagnosis of PEInvestigations in patients with a primary diagnosis of PE –Treatment in patients with PETreatment in patients with PE Thromboprophylaxis - Dr Roopen Arya –Recent major surgery in patients with VTERecent major surgery in patients with VTE –ThromboprophylaxisThromboprophylaxis –Thromboprophylaxis by numbers of risk factorsThromboprophylaxis by numbers of risk factors

Contents cont’d Cancer - Dr Peter Rose –Different cancersDifferent cancers –D-dimerD-dimer –TreatmentTreatment Pregnancy - Dr Denise O’Shaughnessy –DiagnosisDiagnosis –TreatmentTreatment Variation in Treatment Practices - Mr Dan Cummins

Database Overview by Denise O’Shaughnessy on behalf of the VERITY Steering Committee

Number of entries in the database

Risk factors in VTE

Number of risk factors & diagnosis

Age & disease

Age and gender for patients with VTE

Number of risk factors and age in patients with VTE

Rates of different risk factors in patients with VTE

Long distance travel in patients with VTE

Process of VTE diagnosis

D-dimer result and final diagnosis

DVT pre-test probability and final diagnosis

D-dimer result, pre-test probability and final diagnosis

Treatment of VTE

Suitability for home treatment

Reasons not suitable for home treatment

LMWH and warfarin therapy

Outcome data

Pulmonary embolism by Dr. Nicholas Scriven Consultant Chest Physician

Primary diagnosis and final diagnosis

Risk factors in PE

Number of risk factors and diagnosis

Different risk factors

Age and disease

Symptoms in patients with PE

Disease related symptoms

Physiological characteristics

Average PE PTP score

PE PTP score and final diagnosis

Investigations in patients with a primary diagnosis of PE

Use of a D-dimer

Other investigations performed

Treatment in patients with PE

Location of treatment overview

Doses of LMWH

PE PTP score by location of treatment

Thromboprophylaxis By Dr Roopen Arya Consultant Haematologist

Surgical inpatients

Diagnosis by inpatient history

Recent inpatient history

Medical inpatient history

Surgical inpatient history by final diagnosis

Recent major surgery in patients with VTE

Speciality of recent major surgery by age

Thromboprophylaxis

Thromboprophylaxis by recent inpatient history

Thromboprophylaxis by surgical speciality for patients with VTE

Thromboprophylaxis by numbers of risk factors

Medical patients with VTE

Cancer By Dr Peter Rose Consultant Haematologist

Number of patients with VTE and cancer by centre Proportion of patients with VTE and cancer at each centre (n=2,264) 0%10%20%30%40%50%60% Hospital 26 Hospital 12 Hospital 16 Hospital 35 Hospital 15 Hospital 31 Hospital 30 Hospital 07 Hospital 38 Hospital 32 Hospital 22 Hospital 13 Hospital 28 Hospital 14 Hospital 04 Hospital 25 Hospital 06 Hospital 10 Hospital 08 Hospital 09 Hospital 23 Hospital 33 Hospital 34 Hospital 24 Hospital 11 Hospital 27 Hospital 03 Hospital 05 Hospital 37 Hospital 01 Hospital 39 Hospital 02 Centre

Final diagnosis by cancer

Cancer in patients with VTE by age & gender

Cancer in non-VTE patients by age & gender

Different Cancers

Type of cancer by final diagnosis

D-dimer

D-dimer and pre-test probability

Final diagnosis by D-dimer and DVT pre-test probability for patients with cancer

Normalised results and final diagnosis by cancer

Treatment

Location of treatment for cancer patients

Doses of LMWH

Pregnancy by Dr Denise O’Shaughnessy Consultant Haematologist

Pregnancy by final diagnosis

Pregnancy and other risk factors

Diagnosis

Investigations in pregnant patients

Treatment

Use of Low Molecular Weight Heparin therapy

Doses of Low Molecular Weight Heparin therapy

Warfarin therapy

Variation in treatment practices by Mr Dan Cummins Clinical Nurse Specialist

Final diagnosis rate by centre Hospital 16 Hospital 11 Hospital 13 Hospital 37 Hospital 02 Hospital 28 Hospital 24 Hospital 26 Hospital 25 Hospital 06 Hospital 14 Hospital 30 Hospital 03 Hospital 35 Hospital 27 Hospital 15 Hospital 32 Hospital 10 Hospital 04 Hospital 12 Hospital 09 Hospital 38 Hospital 07 Hospital 23 Hospital 08 Hospital 01 Hospital 05 Hospital 22 Hospital 34 Hospital 31 Hospital 33 Hospital 39 Centre VTE diagnosis rate by centre (n=8,830) 0%20%40%60%80%100% Proportion of entries with a final diagnosis of VTE

IV drug use in patients with VTE IV drug use by centre patients with VTE (n=1,626) Proportion of patients who are IV drug users Hospital 39 Hospital 32 Hospital 09 Hospital 10 Hospital 24 Hospital 16 Hospital 35 Hospital 06 Hospital 04 Hospital 12 Hospital 26 Hospital 14 Hospital 31 Hospital 08 Hospital 05 Hospital 01 Hospital 23 Hospital 07 Hospital 38 Hospital 37 Hospital 34 Hospital 33 Hospital 28 Hospital 25 Hospital 22 Hospital 15 Hospital 13 Hospital 11 Hospital 03 Hospital 02 Centre 0%10%20%30%40%50%60%70%80%90%100%

Type of D-dimer test

Time from consultation to Doppler ultrasound by centre for out-of- hospital patients with a primary suspected diagnosis of DVT Hospital 39 Hospital 15 Hospital 24 Hospital 14 Hospital 38 Hospital 09 Hospital 32 Hospital 06 Hospital 02 Hospital 22 Hospital 33 Hospital 07 Hospital 27 Hospital 34 Hospital 10 Hospital 35 Hospital 04 Hospital 12 Hospital 01 Hospital 05 Hospital 30 Hospital 31 Hospital 03 Hospital 23 Hospital 08 Hospital 13 Hospital 37 Hospital 28 Hospital 16 Hospital 26 Hospital 11 Hospital 25 Centre Time from consultation to Doppler ultrasound by centre for out-of-hospital patients with a primary suspected diagnosis of VTE (n=3,949) Days after consultation Days before consultation Average time from consultation to Doppler ultrasound / days

Other investigations for patients who had no D-dimer

Treatment of patients with VTE Average number of LMWH doses and time to therapeutic INR by centre for patients with VE; bars denote standard error (n=1,752 and n=1,623 respectively) Doses of LMWH Time to therapeutic INR Hospital 23 Hospital 14 Hospital 15 Hospital 31 Hospital 24 Hospital 04 Hospital 06 Hospital 37 Hospital 09 Hospital 35 Hospital 11 Hospital 22 Hospital 30 Hospital 25 Hospital 28 Hospital 26 Hospital 13 Hospital 07 Hospital 12 Hospital 02 Hospital 38 Hospital 10 Hospital 16 Hospital 27 Hospital 33 Hospital 32 Hospital 01 Hospital 08 Hospital 03 Hospital 05 Centre Average doses of LMWH and average tine to therapeutic INR / days

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Denise O’Shaughnessy DPhil FRCP FRCPath MBA Peter Rose FRCP FRCPath Nicholas Scriven MRCP Nick Amlot BM Dan Cummins RGN DipHE The VERITY Steering Committee Robin Kinsman PhD Dendrite Clinical Systems