1. VERITY Steering Committee Venous Thromboembolism Registry Second Annual Report 2004

2. 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

3. 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

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

5. Number of entries in the database

6. Risk factors in VTE

8. Number of risk factors & diagnosis

9. Age & disease

10. Age and gender for patients with VTE

11. Number of risk factors and age in patients with VTE

12. Rates of different risk factors in patients with VTE

13. Long distance travel in patients with VTE

14. Process of VTE diagnosis

15. D-dimer result and final diagnosis

16. DVT pre-test probability and final diagnosis

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

18. Treatment of VTE

19. Suitability for home treatment

20. Reasons not suitable for home treatment

21. LMWH and warfarin therapy

22. Outcome data

24. Pulmonary embolism by Dr. Nicholas Scriven Consultant Chest Physician

25. Primary diagnosis and final diagnosis

26. Risk factors in PE

27. Number of risk factors and diagnosis

28. Different risk factors

29. Age and disease

30. Symptoms in patients with PE

31. Disease related symptoms

32. Physiological characteristics

33. Average PE PTP score

34. PE PTP score and final diagnosis

35. Investigations in patients with a primary diagnosis of PE

36. Use of a D-dimer

37. Other investigations performed

38. Treatment in patients with PE

39. Location of treatment overview

40. Doses of LMWH

41. PE PTP score by location of treatment

42. Thromboprophylaxis By Dr Roopen Arya Consultant Haematologist

43. Surgical inpatients

44. Diagnosis by inpatient history

46. Recent inpatient history

47. Medical inpatient history

48. Surgical inpatient history by final diagnosis

49. Recent major surgery in patients with VTE

50. Speciality of recent major surgery by age

51. Thromboprophylaxis

52. Thromboprophylaxis by recent inpatient history

53. Thromboprophylaxis by surgical speciality for patients with VTE

54. Thromboprophylaxis by numbers of risk factors

55. Medical patients with VTE

56. Cancer By Dr Peter Rose Consultant Haematologist

57. 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

58. Final diagnosis by cancer

59. Cancer in patients with VTE by age & gender

60. Cancer in non-VTE patients by age & gender

61. Different Cancers

62. Type of cancer by final diagnosis

63. D-dimer

64. D-dimer and pre-test probability

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

66. Normalised results and final diagnosis by cancer

67. Treatment

68. Location of treatment for cancer patients

69. Doses of LMWH

70. Pregnancy by Dr Denise O’Shaughnessy Consultant Haematologist

71. Pregnancy by final diagnosis

72. Pregnancy and other risk factors

73. Diagnosis

74. Investigations in pregnant patients

75. Treatment

76. Use of Low Molecular Weight Heparin therapy

77. Doses of Low Molecular Weight Heparin therapy

78. Warfarin therapy

79. Variation in treatment practices by Mr Dan Cummins Clinical Nurse Specialist

80. 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

81. 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%

82. Type of D-dimer test

83. 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 -8-7-6-5-4-3-2012345678

84. Other investigations for patients who had no D-dimer

85. 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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87. 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