Thromboprophylaxis patterns, risk factors, and outcomes of care in the medically ill patient population.
BACKGROUND
Medically ill, hospitalized patients are at increased risk for venous thromboembolism (VTE) after discharge. This study aimed to examine thromboprophylaxis patterns, risk factors, and post-discharge outcomes.


METHODS
This was a retrospective claims analysis involving administrative claims data and in-patient data abstracted from a sample of hospital charts. Patients aged ≥ 40 years hospitalized for ≥ 2 days for nonsurgical reasons between 2005 and 2009 were included. Hospital chart data were abstracted for a random sample of patients without evidence of anticoagulant use at 30 days post-discharge. The combined data determined whether in-patient thromboprophylaxis (anticoagulant or mechanical prophylaxis) reduces risk of VTE at 90 days post-discharge. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox proportional hazard models and logistic regression.


RESULTS
Of 141,628 patients in the claims analysis, 3.9% received anticoagulants (3.6% warfarin). VTE, rehospitalization, and mortality rates were 1.9%, 17.2%, and 6.2%, respectively. The strongest predictors of post-discharge VTE were history of VTE (HR=4.0, 95% confidence interval [CI]: 3.3-4.8), and rehospitalization (HR=3.9, 95% CI: 3.6-4.3). Of 504 medical charts, 209 (41.5%) reported in-patient thromboprophylaxis. There was no statistically significant difference in post-discharge VTE rates between patients who did and did not receive in-patient thromboprophylaxis. All-cause mortality was greater among patients without use of VTE prophylaxis.


CONCLUSIONS
Utilization rates of in-hospital and post-discharge VTE prophylaxis were low. In-hospital VTE prophylaxis did not reduce the risk of post-discharge VTE in the absence of post-discharge anticoagulation. Combined in-patient and post-discharge thromboprophylaxis lowered the odds of short-term, all-cause post-discharge mortality.
Presbyterian Healthcare Services, University of New Mexico, Albuquerque, NM, USA.
Charles E
CE
Mahan
Maxine D
MD
Fisher
Roger M
RM
Mills
Larry E
LE
Fields
Judith J
JJ
Stephenson
An-Chen
AC
Fu
Alex C
AC
Spyropoulos
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000453:epidemiology*
D000925:Anticoagulants
CI; DCI; DVT; Deyo-Charlson Comorbidity Index; HIRD; HR; HealthCore Integrated Research Database; ICD-9-CM; International Classification of Diseases, Ninth Revision, Clinical Modification; LMWH; Medical patients; Mortality; OR; PE; Risk factors; SD; Thromboprophylaxis; VTE; Venous thromboembolism; confidence interval; deep vein thrombosis; hazard ratio; low-molecular-weight heparin; odds ratio; pulmonary embolism; standard deviation; venous thromboembolism