Thromboprophylaxis patterns,risk factors,and outcomes of care in the medically ill patient population |
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Authors: | Charles E. Mahan Maxine D. Fisher Roger M. Mills Larry E. Fields Judith J. Stephenson An-Chen Fu Alex C. Spyropoulos |
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Affiliation: | 1. Presbyterian Healthcare Services, University of New Mexico, Albuquerque, NM, USA;2. HealthCore, Inc., Wilmington, DE, USA;3. Janssen Research and Development, Raritan-Titusville, NJ, USA;4. Janssen Scientific Affairs, Raritan, NJ, USA;5. North Shore/LIJ Health System at Lenox Hill Hospital; Hofstra University School of Medicine NY, NY, USA |
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Abstract: | IntroductionMedically 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.MethodsThis 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.ResultsOf 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.ConclusionUtilization 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. |
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Keywords: | CI, confidence interval DCI, Deyo-Charlson Comorbidity Index DVT, deep vein thrombosis HIRD, HealthCore Integrated Research Database HR, hazard ratio ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification LMWH, low-molecular-weight heparin OR, odds ratio PE, pulmonary embolism SD, standard deviation VTE, venous thromboembolism |
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