Hospital Associated Venous Thromboembolism in Oklahoma County

Abstract Introduction: Venous thromboembolism (VTE) is a leading cause of death and disability of the adverse outcomes associated with a hospital stay among low, middle, and high income countries evaluated by the WHO Patient Safety Program. Objective: Compare characteristics and risk factors for hospital associated and non-hospital associated cases of VTE in Oklahoma County from April 1, 2012 to March 31, 2014. Methods: In collaboration with the Centers for Disease Control and Prevention (CDC), a population-based surveillance system for VTE was established in Oklahoma County, OK between April 1, 2012-March 31, 2014 to estimate the incidences of first-time and recurrent VTE events. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. Active surveillance involved reviewing imaging studies (e.g., chest computed tomography and compression ultrasounds of the extremities) from all inpatient and outpatient facilities in the county and collecting demographic, treatment and risk factor data on all VTE case-patients. Hospital associated VTE is defined as a VTE diagnosis made either during the hospital stay or within 90 days of hospital admission, regardless of the reason for hospitalization. Odds ratios and 95% confidence intervals (CI) were calculated. Those age 80+ years were used as the referent age group. Comparisons between hospital associated and non-hospital associated VTE cases were made by using two-sided χ2tests. Results: We identified 2,737 patients with imaging-confirmed VTE. Of these, 1,223 (44.7%) cases were identified as hospital associated and 1,514 (55.3%) cases as non-hospital associated VTE. Of the hospital associated VTE cases, 863 (70.6%) had VTE diagnosed while hospitalized and 360 (29.4%) were diagnosed VTE as outpatients after hospital discharge; of these 360 cases, 239 (66.4%) were re-admitted to the hospital and 121 (33.6%) were managed as outpatients. Of the non-hospital associated VTE cases, 776 (51.3%) were admitted to the hospital after diagnosis and 738 (48.7%) were treated as outpatients. The median length of stay for hospital-associated cases was 8 days (range 1-206 days). The distribution of PE (p = 0.17) and DVT (p = 0.07) were similar in hospital associated cases and non-hospital associated cases. The distributions of race (p = 0.34) and sex (p = 0.17) were similar for patients with and without hospital associated VTE; however, hospital associated cases of VTE tended to be older than non-hospital associated cases (p<0.01; 18-39 years OR = 1.7, 95% CI 1.2-2.2, 40-49 years OR = 1.8, 95% CI 1.3-2.4, 50-59 years OR = 1.3, 95% CI 1.0-1.7, 60-69 years OR = 1.1, 95% CI 0.84-1.4, 70-79 years OR = 1.2, 95% CI 0.91-1.5). Venous catheterization in the last 6 months (OR= 4.4, 95% CI 3.4-5.7), surgery (OR = 3.4, 95% CI 2.8-4.0) and trauma (OR = 3.0, 95% CI 2.3-3.9) in the last 12 months, and histories of: congestive heart failure (OR = 2.6, 95% CI 2.0-3.3), stroke (OR = 2.6, 95% CI 1.9-3.6), myocardial infarction (OR = 2.2, 95% CI 1.6-3.1), superficial vein thrombosis (OR = 1.8, 95% CI 1.3-2.5), and cancer (OR = 1.5, 95% CI 1.3-1.8) were risk factors for hospital associated cases of VTE. Hospital associated VTE cases had 3.5 times the odds of death (95% CI 2.4-5.0) than non-hospital associated cases. Discussion: A significant proportion (45%) of the total VTE burden continues to be hospital associated. A substantial proportion of hospital associated cases are diagnosed after discharge and result in re-admission, with the potential for significant financial penalties under Medicare value-based payment programs. Hospital associated cases of VTE were older, had more risk factors, and were more likely to die than non-hospital associated cases. Disclosures Raskob: Bayer Healthcare: Consultancy; BMS: Consultancy; Daiichi Sankyo: Consultancy; Janssen Pharmaceuticals: Consultancy; Pfizer: Consultancy; ISIS Pharmaceuticals: Consultancy.

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Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival

Blood ◽

10.1182/blood-2008-08-175745 ◽

2009 ◽

Vol 113 (17) ◽

pp. 3911-3917 ◽

Cited By ~ 85

Author(s):

Grace H. Ku ◽

Richard H. White ◽

Helen K. Chew ◽

Danielle J. Harvey ◽

Hong Zhou ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Acute Leukemia ◽

Lymphoblastic Leukemia ◽

Venous Catheter ◽

Population Based ◽

Older Age ◽

Myelogenous Leukemia ◽

Vein Thrombosis ◽

Chronic Comorbidities

Abstract A population-based cohort was used to determine the incidence and risk factors associated with development of venous thromboembolism (VTE) among Californians diagnosed with acute leukemia between 1993 to 1999. Principal outcomes were deep vein thrombosis in both the lower and upper extremities, pulmonary embolism, and mortality. Among 5394 cases with acute myelogenous leukemia (AML), the 2-year cumulative incidence of VTE was 281 (5.2%). Sixty-four percent of the VTE events occurred within 3 months of AML diagnosis. In AML patients, female sex, older age, number of chronic comorbidities, and presence of a catheter were significant predictors of development of VTE within 1 year. A diagnosis of VTE was not associated with reduced survival in AML patients. Among 2482 cases with acute lymphoblastic leukemia (ALL), the 2-year incidence of VTE in ALL was 4.5%. Risk factors for VTE were presence of a central venous catheter, older age, and number of chronic comorbidities. In the patients with ALL, development of VTE was associated with a 40% increase in the risk of dying within 1 year. The incidence of VTE in acute leukemia is appreciable, and is comparable with the incidence in many solid tumors.

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Association between cardiovascular risk-factors and venous thromboembolism in a large longitudinal study of French women

Thrombosis Journal ◽

10.1186/s12959-021-00310-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

C. J. MacDonald ◽

A. L. Madika ◽

M. Lajous ◽

M. Canonico ◽

A. Fournier ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Pulmonary Embolism ◽

Cardiovascular Risk ◽

Venous Thromboembolism ◽

Cardiovascular Risk Factors ◽

Arterial Disease ◽

Population Based ◽

Cox Models ◽

Vein Thrombosis

Abstract Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1000 PY. This included 505 cases of pulmonary embolism and 1144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism after adjustment for BMI. Hypertension, dyslipidaemia and diabetes may not be risk-factors for venous thromboembolism.

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The Epidemiology of Venous Thromboembolism in the Community

Thrombosis and Haemostasis ◽

10.1055/s-0037-1616243 ◽

2001 ◽

Vol 86 (07) ◽

pp. 452-463 ◽

Cited By ~ 313

Author(s):

David Mohr ◽

Tanya Petterson ◽

Christine Lohse ◽

W. Michael O’Fallon ◽

L. Joseph Melton ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Varicose Veins ◽

Hormone Replacement ◽

Malignant Neoplasm ◽

Venous Catheter ◽

The United States ◽

Venous Stasis ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis

SummaryThe incidence of venous thromboembolism exceeds 1 per 1000; over 200,000 new cases occur in the United States annually. Of these, 30% die within 30 days; one-fifth suffer sudden death due to pulmonary embolism. Despite improved prophylaxis, the incidence of venous thromboembolism has been constant since 1980. Independent risk factors for venous thromboembolism include increasing age, male gender, surgery, trauma, hospital or nursing home confinement, malignancy, neurologic disease with extremity paresis, central venous catheter/ transvenous pacemaker, prior superficial vein thrombosis, and varicose veins; among women, risk factors include pregnancy, oral contraceptives, and hormone replacement therapy. About 30% of surviving cases develop recurrent venous thromboembolism within ten years. Independent predictors for recurrence include increasing age, obesity, malignant neoplasm, and extremity paresis. About 28% of cases develop venous stasis syndrome within 20 years. To reduce venous thromboembolism incidence, improve survival, and prevent recurrence and complications, patients with these characteristics should receive appropriate prophylaxis.

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Association Between Cardiovascular Risk-factors and Venous Thromboembolism in a Large Longitudinal Study of French Women

10.21203/rs.3.rs-562012/v1 ◽

2021 ◽

Author(s):

Conor MACDONALD ◽

AL Madika ◽

Martin Lajous ◽

M Canonico ◽

Agnes Fournier ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Pulmonary Embolism ◽

Cardiovascular Risk ◽

Venous Thromboembolism ◽

Cardiovascular Risk Factors ◽

Arterial Disease ◽

Population Based ◽

Cox Models ◽

Vein Thrombosis

Abstract Background Previous studies have shown conflicting results regarding the influence of cardiovascular risk-factors on venous thromboembolism. This study aimed to determine if these risk-factors, i.e. physical activity, smoking, hypertension, dyslipidaemia, and diabetes, were associated with the risk of venous thromboembolism, and to determine if these associations were confounded by BMI. Methods We used data from the E3N cohort study, a French prospective population-based study initiated in 1990, consisting of 98,995 women born between 1925 and 1950. From the women in the study we included those who did not have prevalent arterial disease or venous thromboembolism at baseline; thus 91,707 women were included in the study. Venous thromboembolism cases were self-reported during follow-up, and verified via specific mailings to medical practitioners or via drug reimbursements for anti-thrombotic medications. Hypertension, diabetes and dyslipidaemia were self-reported validated against drug reimbursements or specific questionnaires. Physical activity, and smoking were based on self-reports. Cox-models, adjusted for BMI and other potential risk-factors were used to determine hazard ratios for incident venous thromboembolism. Results During 1,897,960 person-years (PY), 1, 649 first incident episodes of thrombosis were identified at an incidence rate of 0.9 per 1,000 PY. This included 505 cases of pulmonary embolism and 1,144 cases of deep vein thrombosis with no evidence of pulmonary embolism. Hypertension, dyslipidaemia, diabetes, smoking and physical activity were not associated with the overall risk of thrombosis after adjustment for BMI. Conclusions Traditional cardiovascular risk factors were not associated with the risk of venous thromboembolism. Hypertension, dyslipidaemia and diabetes should not be considered risk-factors for venous thromboembolism.

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Venous thromboembolism

Obstetric Medicine ◽

10.1093/med/9780198821540.003.0010 ◽

2020 ◽

pp. 363-372

Author(s):

Charlotte Frise ◽

Sally Collins

Keyword(s):

Risk Factors ◽

Molecular Weight ◽

Venous Thromboembolism ◽

Low Molecular Weight Heparin ◽

Superficial Vein ◽

Mortality And Morbidity ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis ◽

Maternal Mortality And Morbidity ◽

Deep Vein

Venous thromboembolism is a major cause of maternal mortality and morbidity. This chapter discusses thromboprophylaxis (including low-molecular-weight heparin and doses by patient weight), risk factors, deep vein thrombosis, pulmonary embolism, associated investigations, and management. Anticoagulants and bleeding while anticoagulated are both covered. Finally, superficial vein thrombosis in the first month postpartum is described.

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Risk factors for incident venous thromboembolism in active cancer patients: A population based case–control study

Thrombosis Research ◽

10.1016/j.thromres.2016.01.002 ◽

2016 ◽

Vol 139 ◽

pp. 29-37 ◽

Cited By ~ 29

Author(s):

Aneel A. Ashrani ◽

Rachel E. Gullerud ◽

Tanya M. Petterson ◽

Randolph S. Marks ◽

Kent R. Bailey ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Case Control Study ◽

Population Based ◽

Case Control ◽

Control Study ◽

Active Cancer

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Abstract P254: Risk Factors For Venous Thromboembolism in a Cohort of French Women

Circulation ◽

10.1161/circ.125.suppl_10.ap254 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Martin Lajous ◽

Laura Tondeur ◽

Agnes Fournier ◽

Francoise Clavel-Chapelon

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Cardiovascular Disease ◽

Venous Thromboembolism ◽

Fruits And Vegetables ◽

Smoking Status ◽

Premenopausal Women ◽

Prior History ◽

Inverse Association ◽

Vein Thrombosis

Background: There is controversy over whether cardiovascular disease and venous thromboembolism (VTE) share risk factors. Prospective information on risk factors for VTE in otherwise healthy individuals is limited. Methods and Results We evaluated the relation between known risk factors for cardiovascular disease and incidence of VTE among 65,272 French women in the E3N prospective cohort study with no prior history of VTE and who were free of cardiovascular disease or cancer in 1993. All information was self-reported via mailed questionnaires and diet and physical activity were assessed using previously validated instruments. Between 1993 and 2007, 766 cases of deep vein thrombosis or pulmonary embolism were first identified through self-reports and validated using medical records and information from treating physicians. Cases were considered valid if the diagnosis was based on an imaging procedure. We evaluated the following risk factors: education, menopause, postmenopausal hormone use, treated hypercholesterolemia and hypertension, diabetes, body mass index (BMI), physical activity, smoking status and intake of alcohol, red meat, fish, fruits and vegetables, fiber and coffee. In a multivariable model with age as the time scale, we found that, compared to women with a BMI <22 kg/m2, the HR (95%CI) was 1.35 (1.14, 1.60) for 22–24.9 kg/m2, 2.11 (1.73, 2.57) for 25–29.9 kg/m2 and 2.88 (2.08, 3.98) for ≥30 kg/m2 and the p-trend was <0.0001. Menopause was found to be inversely associated with VTE risk [HR=0.60 (95%CI 0.45–0.80); postmenopausal vs. premenopausal women]. In analyses restricted to postmenopausal women, relative to never users current use of postmenopausal hormones was significantly associated to VTE risk [HR=1.44 (95%CI 1.18–1.74)]. No significant association was found with dietary and other cardiovascular risk factors. Conclusion In this large prospective study only some risk factors for cardiovascular disease were associated to VTE incidence. We observed a strong inverse association between menopause and VTE.

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