Venous Thromboembolism Prophylaxis and Risk in the Inpatient and Outpatient Continuum of Care Among Hospitalized Acutely Ill Patients in the US: A Retrospective Analysis
- 95 Downloads
Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality among hospitalized patients in the US. The objectives of this study were to examine VTE prophylaxis patterns and risk for VTE events during hospitalization and post-discharge among patients hospitalized for acute illnesses in the US.
Acutely ill hospitalized patients were identified from the MarketScan databases (January 1, 2012–June 30, 2015). Proportions of patients that received inpatient and/or outpatient VTE prophylaxis were determined. VTE rates were calculated for the overall study population and for each subpopulation with each acute illness type. Risk for VTE events after the index admission was determined by Kaplan–Meier analysis.
Of the acutely ill patients (n = 17,895, mean age: 58.4 years), most were hospitalized for infectious diseases (40.6%), followed by respiratory diseases (31.0%), cancer (10.7%), heart failure (10.4%), ischemic stroke (6.4%), and rheumatic diseases (0.9%). Among the entire study population, 59.1% did not receive any VTE prophylaxis, and only 7.1% received both inpatient and outpatient prophylaxis. Among the overall study population, cumulative VTE rate, including during index admission and within 6 months post-discharge, was 4.6%. VTE risk in the inpatient and outpatient continuum of care remained elevated up to 30-40 days after hospital admission, with 60.1% of VTEs occurring within 40 days of hospital admission.
In this retrospective analysis of nearly 18,000 patients hospitalized for acute illnesses, 59.1% did not receive any VTE prophylaxis and only 7.1% received VTE prophylaxis in both the inpatient and outpatient continuum of care, despite significant VTE risk extending from hospitalization into the post-discharge period.
KeywordsAcute illness Cardiology Hospitalized patients Inpatient and outpatient continuum of care Prophylaxis Venous thromboembolism
Sponsorship for this study, development of this manuscript and article processing charges were funded by Portola Pharmaceuticals. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Alpesh Amin is a research consultant and/or speaker for Novosys Health, Portola, BI, BMS, and Pfizer. Alpesh Amin did not receive funding for manuscript development. W Richey Neuman is an employee of Portola Pharmaceuticals. Melissa Lingohr-Smith is an employee of Novosys Health, who has received research funds from Portola Pharmaceuticals in connection with conducting this study and development of this manuscript. Brandy Menges is an employee of Novosys Health, who has received research funds from Portola Pharmaceuticals in connection with conducting this study and development of this manuscript. Jay Lin is an employee of Novosys Health, who has received research funds from Portola Pharmaceuticals in connection with conducting this study and development of this manuscript.
Compliance with Ethics Guidelines
In compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the databases utilized for this retrospective claims database analysis consist of fully de-identified data sets, with synthetic identifiers applied to patient-level and provider-level data to protect the identities of both the patients and data contributors. The study was exempt from requiring Institutional Review Board approval as it involved the assessment of retrospective and de-identified data.
All data generated or analyzed during this study are included in this published article.
- 4.Mahan CE, Borrego ME, Woersching AL, et al. Venous thromboembolism: annualised United States models for total, hospital-acquired and preventable costs utilising long-term attack rates. Thromb Haemost. 2012;108:291v302.Google Scholar
- 5.Huang W, Cohen A, Zayaruzny M, et al. Impact of evolving ACCP guidelines on estimates of venous thromboembolism risk in US hospitals. International Society on Thrombosis and Haemostatsis (ISTH). July 8-13, 2017. Berlin Germany. Res Pract Thromb Haemost. 2017;1(Suppl S1):1–1451.Google Scholar
- 21.Clark CL, Shams AH, Chang AM, et al. D-dimer in acute medically ill adults and current thromboprophylaxis: a multicenter observational study evaluating the prevalence of elevated D-dimer in acute medically ill, hospitalized adults and current thromboprophylaxis trends; the DAMIACT study, initial data analysis. International Society on Thrombosis and Haemostatsis (ISTH). July 8-13, 2017. Berlin Germany. Res Pract Thromb Haemost. 2017; 1(Suppl S1):1 − 1451.Google Scholar