title: Rate of deep-vein thrombosis and pulmonary embolism during the care continuum in patients with acute ischemic stroke in the United States.
abstract: BACKGROUND
  Deep-vein thrombosis (DVT) and pulmonary embolism (PE) are frequent and life-threatening complications of ischemic stroke. We evaluated rates of symptomatic DVT/PE, and of in-hospital and post-discharge thromboprophylaxis in patients with acute ischemic stroke (AIS).
  
  
  METHODS
  In a retrospective US database analysis, data were extracted from the Premier Perspective™-i3 Pharma Informatics linked database for patients aged ≥18 years who were hospitalized for ischemic stroke from January 2005 to November 2007, and who had ≥6 months' continuous plan enrollment prior to index hospitalization. Patients discharged to an acute-care facility or with atrial fibrillation were excluded. Prophylaxis was evaluated during index hospitalization and for 14 days' post-discharge. DVT/PE rates were calculated during index hospitalization and up to 30 days post-discharge.
  
  
  RESULTS
  A total of 1524 patients were included; 46.1% received pharmacological and/or mechanical prophylaxis in-hospital (28.3%, 11.4% and 12.3% received unfractionated heparin, enoxaparin and mechanical prophylaxis, respectively). 6.4% of patients received outpatient pharmacological prophylaxis; warfarin was most frequently prescribed (5.9%). Total mean ± standard deviation length of index hospitalization was 3.0 ± 2.5 days. Mean prophylaxis duration in all patients was 0.9 ± 1.5 days in-hospital and 1.7 ± 6.9 days post-discharge. Symptomatic DVT/PE occurred in 25 patients overall (1.64%), with an inpatient rate of 0.98% and an outpatient rate of 0.66%.
  
  
  CONCLUSIONS
  Approximately 1% of patients with AIS experienced symptomatic in-hospital and/or post-discharge DVT/PE. Although 46% received prophylaxis in-hospital, only 6% received prophylaxis in the outpatient setting. This highlights the need for sustained thromboprophylaxis prescribing across the continuum of care.
authors: Department of Medicine, University of California-Irvine, Orange, CA 92868, USA. anamin@uci.edu
authors: Alpesh N
authors: AN
authors: Amin
authors: Jay
authors: J
authors: Lin
authors: Stephen
authors: S
authors: Thompson
authors: Daniel
authors: D
authors: Wiederkehr
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
references: Stroke. 2013 Jan;44(1):249-51
references: 23117723
references: JAMA. 1973 Jun 11;224(11):1493-5
references: 4739951
references: BMC Neurol. 2006 Jun 01;6:20
references: 16740167
references: Ann Intern Med. 2010 Nov 2;153(9):553-62
references: 20855784
references: Stroke. 2001 Jan;32(1):262-7
references: 11136946
references: Am J Health Syst Pharm. 2006 Oct 15;63(20 Suppl 6):S23-9
references: 17032931
references: Arch Intern Med. 2004 Sep 13;164(16):1761-8
references: 15364669
references: J Thromb Thrombolysis. 2010 Apr;29(3):326-39
references: 19548071
references: Age Ageing. 1986 Mar;15(2):84-8
references: 3962762
references: Lancet. 2009 Jun 6;373(9679):1958-65
references: 19477503
references: Vital Health Stat 13. 2007 Dec;(165):1-209
references: 18350768
references: Stroke. 2006 Jan;37(1):139-44
references: 16306456
references: Arch Phys Med Rehabil. 2004 Jul;85(7):1070-5
references: 15241752
references: Stroke. 2010 Jul;41(7):1326-31
references: 20489177
references: Stroke. 2004 Oct;35(10):2320-5
references: 15322298
references: J Thromb Haemost. 2007 Aug;5(8):1610-6
references: 17663733
references: Chest. 2008 Jun;133(6 Suppl):630S-669S
references: 18574275
references: Stroke. 1981 Jul-Aug;12(4):474-7
references: 7314170
references: Neurology. 2005 Aug 9;65(3):360-5
references: 16087898
references: J Thromb Haemost. 2005 Jun;3(6):1187-94
references: 15946209
references: Lancet. 1987 Mar 7;1(8532):523-6
references: 2434815
references: Acta Med Scand. 1987;222(5):401-8
references: 3425392
references: Thromb Haemost. 2010 Apr;103(4):736-48
references: 20135072
references: Lancet. 2007 Apr 21;369(9570):1347-1355
references: 17448820
references: Acta Neurol Scand. 2002 Aug;106(2):84-92
references: 12100367
references: Haemostasis. 1989;19(5):245-50
references: 2550335
references: Top Stroke Rehabil. 2005 Fall;12(4):1-10
references: 16698732