title: Treatment patterns and outcomes among hospitalized patients with venous thromboembolism in the United States: an analysis of electronic health records data.
abstract: BACKGROUND
  With the advent of new treatment options for venous thromboembolism (VTE), it is valuable to gain insights into current clinical practices.
  
  
  OBJECTIVE
  Assess treatment patterns and recurrence among patients hospitalized for VTE.
  
  
  METHODS
  This retrospective study evaluated patients hospitalized with an incident VTE diagnosis (index) from 2008 to 2012 in a de-identified electronic health record database. Patients were further required to receive anticoagulant treatment and/or a VTE-related procedure for study inclusion. Patients were excluded if they: (1) did not have a medical encounter in the 6 months before index (baseline); (2) had a prior VTE diagnosis or used an anticoagulant during the baseline period; or (3) had a diagnosis of atrial fibrillation/flutter, cardiomyopathy, or a coagulation disorder during baseline or the year after index (follow-up). Hospitalization for recurrent VTE and bleeding were evaluated.
  
  
  RESULTS
  A total of 2060 patients were identified (mean age, 60.9 years; 53.0% women), with a mean length of stay of 8.1 days. Of the VTE types, acute DVT was the most common (41.9%), followed by PE (33.3%), and DVT + PE (24.7%). Almost all patients (96.9%) received anticoagulants, of which 94.3% received heparin and 76.5% received warfarin. Although 77.4% of warfarin users were prescribed it at discharge, only (40.2%) had a warfarin prescription within 30 days of discharge. Overall 30 day, 90 day and 1-year VTE recurrence rates were 2.0%, 4.2%, and 7.5%, respectively, and the major bleeding rate was 6.8%.
  
  
  CONCLUSIONS
  In a real-world population of hospitalized VTE patients, heparin treatment in combination with warfarin was common. However, continuation of warfarin post-discharge was challenging. Initiatives to improve continuation of therapy may be important to reduce VTE recurrence.
authors.affiliation: Boston Health Economics, Inc., Waltham, MA.jmenzin@bhei.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Menzin
authors.forename: Ronald
authors.initials: R
authors.lastname: Preblick
authors.forename: Mark
authors.initials: M
authors.lastname: Friedman
authors.forename: Jordan
authors.initials: J
authors.lastname: Menzin
authors.forename: Molly
authors.initials: M
authors.lastname: Frean
authors.forename: Winghan
authors.initials: W
authors.lastname: Jacqueline Kwong
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D057286:Electronic Health Records; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D020246:Venous Thrombosis / Q000188:drug therapy*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin