Observational studyBMJ open2020
Bleeding and thrombotic complications during treatment with direct oral anticoagulants or vitamin K antagonists in venous thromboembolic patients included in the prospective, observational START2-register.
Observational study in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 14 citations in OpenAlex.
- Reduced- Compared with Standard-Dose Direct Oral Anticoagulant for Extended Treatment of Venous Thromboembolism: A Systematic Review and Meta-Analysis.TH open : companion journal to thrombosis and haemostasis · 2026Article
- A systematic review of the biological effects of resveratrol on venous thromboembolism.Avicenna journal of phytomedicine · 2026Review
- Α 6-month, multicenter, observational study investigating the treatment of venous thromboembolism in Greece (VICTORIA study).Thrombosis journal · 2025Article
- DOACs use in extreme body-weighted patients: results from the prospective START-register.Internal and emergency medicine · 2023Observational
- Clinical impact of high platelet reactivity in patients with atrial fibrillation and concomitant percutaneous coronary intervention on dual or triple antithrombotic therapy.Journal of thrombosis and thrombolysis · 2023Observational
- Examine the Moderating Role of Teacher's Self-Efficacy in the Relationship Between the Job Satisfaction and Professional Learning Community in China.Frontiers in psychology · 2022Article
- The effect of health literacy on vaccine hesitancy among Italian anticoagulated population during COVID-19 pandemic: the moderating role of health engagement.Human vaccines & immunotherapeutics · 2021Article
- Management and Outcomes of Isolated Distal Deep Vein Thromboses: A Questionable Trend toward Long-Lasting Anticoagulation Treatment. Results from the START-Register.TH open : companion journal to thrombosis and haemostasis · 2021Article
- Anticoagulation Duration After First Venous Thromboembolism: Real-Life Data From the International, Observational WHITE Study.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisObservational
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe proportion and characteristics of Italian patients affected by venous thromboembolism (VTE) treated with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), and complications occurring during follow-up.
designA prospective cohort of 2728 VTE patients included in the Survey on anticoagulaTed pAtients RegisTer (START2-Register) from January 2014 to June 2018 was investigated. Characteristics of patients, type of treatment and complications occurring during 2962 years of follow-up were analysed.
settingAbout 60 Italian anticoagulation and thrombosis centres participated in the observational START2-Register
participants2728 adult patients with VTE of a lower limb and/or pulmonary embolism (PE), with a follow-up after the initial phase treatment.
interventionsPatients could receive DOACs or VKAs; both prescribed by the National and Regional Health Systems for patients with VTE. OUTCOMES MEASURES: Efficacy: rate of VTE recurrence (all thrombotic complications were also recorded). SAFETY: the rate of major and clinically relevant non-major bleeding events.
resultsAlmost 80% of patients were treated with DOACs. The prevalence of symptomatic PE and impaired renal function was higher in patients receiving VKAs. Duration of anticoagulation was >180 days in approximately 70% of patients. Bleeding events were similar in both treatment groups. The overall eventuality of recurrence was significantly higher in DOAC cohorts versus VKA cohorts (HR 2.15 (1.14-4.06), p=0.018); the difference was almost completely due to recurrences occurring during extended treatment (2.73% DOAC vs 0.49% VKA, p<0.0001). All-cause mortality was higher in VKA-treated (5.9%) than in DOAC-treated patients (2.6%, p<0.001).
conclusionItalian centres treat most patients with VTE with DOACs and prefer VKA for those with more serious clinical conditions. Recurrences were significantly more frequent in DOAC-treated patients due to increased incidence after 180 days of treatment, probably due to reduced adherence to treatment. These results underline the importance of structured surveillance of DOAC-treated patients with VTE to strengthen treatment adherence during extended therapy.
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