Advertisement

Advances in Therapy

, Volume 36, Issue 1, pp 59–71 | Cite as

Venous Thromboembolism Prophylaxis and Risk in the Inpatient and Outpatient Continuum of Care Among Hospitalized Acutely Ill Patients in the US: A Retrospective Analysis

  • Alpesh AminEmail author
  • W. Richey Neuman
  • Melissa Lingohr-Smith
  • Brandy Menges
  • Jay Lin
Original Research
  • 95 Downloads

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

Funding

Portola Pharmaceuticals.

Keywords

Acute illness Cardiology Hospitalized patients Inpatient and outpatient continuum of care Prophylaxis Venous thromboembolism 

Notes

Acknowledgements

Funding

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.

Authorship

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.

Disclosures

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.

Data Availability

All data generated or analyzed during this study are included in this published article.

References

  1. 1.
    Cardoso LF, Krokoscz DV, de Paiva EF, et al. Results of a venous thromboembolism prophylaxis program for hospitalized patients. Vasc Health Risk Manag. 2016;12:491–6.CrossRefGoogle Scholar
  2. 2.
    Heit JA, Crusan DJ, Ashrani AA, et al. Effect of a near-universal hospitalization-based prophylaxis regimen on annual number of venous thromboembolism events in the US. Blood. 2017;130:109–14.CrossRefGoogle Scholar
  3. 3.
    Grosse SD, Nelson RE, Nyarko KA, et al. The economic burden of incident venous thromboembolism in the United States: a review of estimated attributable healthcare costs. Thromb Res. 2016;137:3–10.CrossRefGoogle Scholar
  4. 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. 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
  6. 6.
    Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: american College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e195S–226S.CrossRefGoogle Scholar
  7. 7.
    Alikhan R, Cohen AT, Combe S, et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med. 2004;164:963–8.CrossRefGoogle Scholar
  8. 8.
    Anderson FA, Zayaruzny M, Heit JA, et al. Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism. Am J Hematol. 2007;82:777–82.CrossRefGoogle Scholar
  9. 9.
    Amin AN, Varker H, Princic N, et al. Duration of venous thromboembolism risk across a continuum in medically ill hospitalized patients. J Hosp Med. 2012;7:231–8.CrossRefGoogle Scholar
  10. 10.
    Cohen AT, Harrington RA, Goldhaber SZ, APEX Investigators, et al. Extended thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med. 2016;375:534–44.CrossRefGoogle Scholar
  11. 11.
    Cohen AT, Spiro TE, Buller HR, The MAGELLAN Investigators, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368:513–23.CrossRefGoogle Scholar
  12. 12.
    Mahan CE, Fisher MD, Mills RM, et al. Thromboprophylaxis patterns, risk factors, and outcomes of care in the medically ill patient population. Thromb Res. 2013;132:520–6.CrossRefGoogle Scholar
  13. 13.
    Flanders SA, Greene MT, Grant P, et al. Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism: a cohort study. JAMA Intern Med. 2014;174:1577–84.CrossRefGoogle Scholar
  14. 14.
    Pendergraft T, Liu X, Edelsberg J, et al. Prophylaxis against venous thromboembolism in hospitalized medically ill patients. Circ Cardiovasc Qual Outcomes. 2013;6:75–82.CrossRefGoogle Scholar
  15. 15.
    Amin AN, Stemkowski S, Lin J, et al. Inpatient thromboprophylaxis use in U.S. hospitals: adherence to the seventh American College of Chest Physician’s recommendations for at-risk medical and surgical patients. J Hosp Med. 2009;4:E15–21.CrossRefGoogle Scholar
  16. 16.
    Tapson VF, Decousus H, Pini M, et al. IMPROVE Investigators. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest. 2007;132:936–45.CrossRefGoogle Scholar
  17. 17.
    Cohen AT, Tapson VF, Bergmann JF, et al. ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371:387–94.CrossRefGoogle Scholar
  18. 18.
    Spyropoulos AC, Raskob GE. New paradigms in venous thromboprophylaxis of medically ill patients. Thromb Haemost. 2017;117:1662–70.CrossRefGoogle Scholar
  19. 19.
    Cohen AT, Spiro TE, Spyropoulos AC, et al. D-dimer as a predictor of venous thromboembolism in acutely ill, hospitalised patients: a subanalysis of the randomized controlled MAGELLAN trial. J Thromb Haemost. 2014;12:479–87.CrossRefGoogle Scholar
  20. 20.
    Mebazaa A, Spiro TE, Büller HR, et al. Predicting the risk of venous thromboembolism in patients hospitalised with heart failure. Circulation. 2014;130:410–8.CrossRefGoogle Scholar
  21. 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
  22. 22.
    Hull RD, Schellong SM, Tapson VF, et al. Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recently reduced mobility: a randomized trial. Ann Intern Med. 2010;153:8–18.CrossRefGoogle Scholar
  23. 23.
    Goldhaber SZ, Leizorovicz A, Kakkar AK, et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med. 2011;365:2167–77.CrossRefGoogle Scholar
  24. 24.
    Gibson CM, Korjian S, Chi G, et al. Comparison of fatal or irreversible events with extended-duration betrixaban versus standard dose enoxaparin in acutely ill medical patients: an APEX trial substudy. J Am Heart Assoc. 2017;6:e006015.CrossRefGoogle Scholar
  25. 25.
    Chi G, et al. Extended-duration betrixaban reduces the risk of rehospitalization associated with venous thromboembolism among acutely ill hospitalized medical patients: findings from the APEX trial. Circulation. 2018;137:91–4.CrossRefGoogle Scholar

Copyright information

© Springer Healthcare Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Alpesh Amin
    • 1
    Email author
  • W. Richey Neuman
    • 2
  • Melissa Lingohr-Smith
    • 3
  • Brandy Menges
    • 3
  • Jay Lin
    • 3
  1. 1.School of MedicineUniversity of CaliforniaIrvineUSA
  2. 2.Portola PharmaceuticalsSouth San FranciscoUSA
  3. 3.Novosys HealthGreen BrookUSA

Personalised recommendations