title: All-cause mortality and use of antithrombotics within 90 days of discharge in acutely ill medical patients.
abstract: Conflicting evidence exists regarding predictors of and antithrombotic benefit on mortality in hospitalised acutely-ill medical patients. We compared mortality risk within 90 days post-discharge among medically ill patients who did and did not receive antithrombotics. This retrospective claims analysis included patients ≥ 40 years with nonsurgical hospitalisation ≥ 2 days between 2005 and 2009 using the HealthCore Integrated Research Database. Antithrombotic use (i.e. anticoagulants and antiplatelets) post-discharge was captured from pharmacy claims. All-cause mortality was determined from Social Security Death Index; cause of death was identified from National Death Index database. Kaplan-Meier survival curves were generated and hazard ratios (HR) for mortality risk were estimated using Cox proportional hazards models. Patients prescribed anticoagulants or antiplatelets post-discharge had lower risk of short-term mortality. For the anticoagulant model, the most significant predictors of mortality were malignant/benign neoplasms (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.5-1.7), liver disease (HR 1.6, 95% CI 1.5-1.7), anticoagulant omission (HR 1.6, 95% CI 1.4-1.8), gastrointestinal or respiratory tract intubations (HR 1.5, 95% CI 1.3-1.7), and blood dyscrasias (HR 1.4, 95% CI 1.4-1.5). For the antiplatelet model, the most significant predictors of mortality were antiplatelet omission (HR 3.7, 95% CI 3.3-4.1), liver disease (HR 1.6, 95% CI 1.4-1.7), malignant/benign neoplasms (HR 1.6, 95% CI 1.5-1.6), gastrointestinal or respiratory tract intubations (HR 1.5, 95% CI 1.3-1.7), and blood dyscrasias (HR 1.4, 95% CI 1.4-1.5). These mortality risk factors may guide future studies assessing potential benefits of antithrombotics in specific subsets of patients.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Mahan
authors.forename: Larry E
authors.initials: LE
authors.lastname: Fields
authors.forename: Roger M
authors.initials: RM
authors.lastname: Mills
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.forename: An-Chen
authors.initials: AC
authors.lastname: Fu
authors.forename: Maxine D
authors.initials: MD
authors.lastname: Fisher
authors.affiliation: Alex C Spyropoulos, MD, FACP, FCCP, FRCPC, Professor of Medicine, Hofstra North Shore-LIJ School of Medicine, 130 E &77th St 10075, Manhasset, NY, USA, Tel.: +1 212 434 6776, Fax: +1 212 434 6781, E-mail: aspyropoul@nshs.edu.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Spyropoulos
mesh_terms: D000208:Acute Disease / Q000401:mortality*; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: Mortality; anticoagulants; antiplatelet agents; medical patients; risk factors