Long-term complications of medical patients with hospital-acquired venous thromboembolism.
Long-term complications from hospital-acquired acute venous thromboembolism (VTE) include recurrent VTE, postthrombotic syndrome (PTS), and chronic thromboembolic pulmonary hypertension (CTEPH). We used a probability model to estimate the number of these events among hospitalised medical patients in the 2003 United States Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample database. Of 8,077,919 hospitalised medical patients at risk for VTE, we calculate that 122,235 were stricken with deep vein thrombosis (DVT) and 32,654 with pulmonary embolism (PE). These events generated 49,843 VTE-related deaths, 28,052 recurrent DVTs, 6,680 recurrent PEs, 140,156 cases of PTS, and 5,288 cases of CTEPH over the ensuing 5 years, for a total of 180,176 patients afflicted with long-term complications of VTE. In our model, rates of pharmacological thromboprophylaxis prescribing varied across populations, ranging from 15.3% to 49.2%. When we modeled universal utilisation of pharmacological prophylaxis, the number of VTE-related deaths decreased from 49,843 to 20,739, recurrent DVT was reduced from 28,052 to 13,384, and recurrent PE was reduced from 6,680 to 3,187 events. Incident cases of PTS decreased from 140,156 to 54,651, and CTEPH decreased from 5,288 to 1,115 cases. The number of hospitalised medical patients with long-term VTE complications was reduced by 60% to 72,337. In conclusion, hospitalised medical patients are particularly vulnerable to the development of recurrent VTE, PTS, and CTEPH. These VTE complications would be reduced by more than half with universal thromboprophylaxis. Further efforts should focus on improving VTE prophylaxis utilisation.
Fanikos
John
J
Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Piazza
Gregory
G
Zayaruzny
Maksim
M
Goldhaber
Samuel Z
SZ
D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D015233:Models, Statistical; D054070:Postthrombotic Syndrome / Q000209:etiology* / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D054556:Venous Thromboembolism / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology
D000925:Anticoagulants