ASO Author Reflections: Post-Discharge Venous Thromboembolism Incidence and Risk Factors

Background and Purpose: Risk of venous thromboembolism (VTE) in stroke patients persists after discharge from hospital due to residual deficits. Quantification of VTE risk at various post-discharge intervals may have implications for surveillance and/or prophylactic strategies for high-risk individuals. We therefore, studied incidence rates and risk factors of deep venous thrombosis (DVT) and pulmonary embolism (PE) among stroke survivors after discharge from the hospital. Methods: Adults with principle diagnosis of ischemic stroke discharged alive from acute care hospitals in California State between January 2005 and December 2010 were followed up until December 2011 using state inpatient and emergency department databases for development of DVT and/or PE. Case ascertainment was done using International Classification of Diseases -9 codes. We calculated incidence rates of DVT and PE during first 30 days, 31-90 days, 91-365 days and >1-year after the discharge. We calculated independent risk factors for VTE within 90 days after discharge by using logistic regression controlling for baseline demographics, comorbidities, inpatient complications and procedures. Results: A total of 168,194 stroke survivors were followed up for a mean duration of 3.6+/-1.9 (SD) years after discharge. Among these, 6,179 (3.7%) developed DVT and 2,487 (1.5%) developed PE resulting in incidence rate of 1.02 and 0.41 per 100 person year for DVT and PE respectively. The incidence rates of DVT during first 30 days, 31-90 days, 91-365 days and >1-year post-discharge were 6.53, 2.91, 1.24 and 0.66 per 100 person year respectively. Similarly, the incidence of PE was 3.04, 1.13, 0.46 and 0.26 during first 30 days, 31-90 days, 91-365 days and >1-year after discharge respectively. Factors independently associated with VTE within 90 days were age>65 years, African-American race, higher Charlson comorbidity index, metastatic cancer, anemia, obesity, acute myocardial infarction, pneumonia, sepsis, hemodialysis, gastrostomy and mechanical ventilation during index admission. Conclusions: VTE risk remains high among stroke survivors even after discharge from the hospital. The risk is highest during first 30 days and remains high as long as 1 year after discharge.

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Risk factors for post-discharge venous thromboembolism in patients undergoing colorectal resection: a NSQIP analysis

Techniques in Coloproctology ◽

10.1007/s10151-018-1909-8 ◽

2018 ◽

Vol 22 (12) ◽

pp. 955-964 ◽

Cited By ~ 8

Author(s):

N. Alhassan ◽

M. Trepanier ◽

C. Sabapathy ◽

P. Chaudhury ◽

A. S. Liberman ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Colorectal Resection ◽

Post Discharge

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Timing and Perioperative Risk Factors for In-Hospital and Post-Discharge Venous Thromboembolism After Colorectal Cancer Resection

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029611433642 ◽

2012 ◽

Vol 18 (6) ◽

pp. 569-575 ◽

Cited By ~ 28

Author(s):

Daniel L. Davenport ◽

H. David Vargas ◽

Michael W. Kasten ◽

Eleftherios S. Xenos

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Venous Thromboembolism ◽

Perioperative Risk ◽

Post Discharge ◽

Cancer Resection ◽

Perioperative Risk Factors ◽

Colorectal Cancer Resection

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Premature Arterial Disease Associated with Familial Antithrombin III Deficiency

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645677 ◽

1990 ◽

Vol 63 (01) ◽

pp. 013-015 ◽

Cited By ~ 15

Author(s):

E J Johnson ◽

C R M Prentice ◽

L A Parapia

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Potential Risk ◽

Antithrombin Iii ◽

Arterial Disease ◽

Coagulation System ◽

Early Age ◽

Arterial Thromboembolism ◽

Potential Risk Factors ◽

Antithrombin Iii Deficiency

SummaryAntithrombin III (ATIII) deficiency is one of the few known abnormalities of the coagulation system known to predispose to venous thromboembolism but its relation to arterial disease is not established. We describe two related patients with this disorder, both of whom suffered arterial thrombotic events, at an early age. Both patients had other potential risk factors, though these would normally be considered unlikely to lead to such catastrophic events at such an age. Thrombosis due to ATIII deficiency is potentially preventable, and this diagnosis should be sought more frequently in patients with arterial thromboembolism, particularly if occurring at a young age. In addition, in patients with known ATIII deficiency, other risk factors for arterial disease should be eliminated, if possible. In particular, these patients should be counselled against smoking.

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Post Discharge Clinically Overt Venous Thromboembolism in Orthopaedic Surgery Patients with Negative Venography -an Overview Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650681 ◽

1996 ◽

Vol 76 (06) ◽

pp. 0887-0892 ◽

Cited By ~ 32

Author(s):

Serena Ricotta ◽

Alfonso lorio ◽

Pasquale Parise ◽

Giuseppe G Nenci ◽

Giancarlo Agnelli

Keyword(s):

Venous Thromboembolism ◽

Orthopaedic Surgery ◽

Diagnostic Methods ◽

Future Research ◽

Post Discharge ◽

Pharmacological Prophylaxis ◽

Vein Thrombosis ◽

Overview Analysis ◽

Major Orthopaedic Surgery

SummaryA high incidence of post-discharge venous thromboembolism in orthopaedic surgery patients has been recently reported drawing further attention to the unresolved issue of the optimal duration of the pharmacological prophylaxis. We performed an overview analysis in order to evaluate the incidence of late occurring clinically overt venous thromboembolism in major orthopaedic surgery patients discharged from the hospital with a negative venography and without further pharmacological prophylaxis. We selected the studies published from January 1974 to December 1995 on the prophylaxis of venous thromboembolism after major orthopaedic surgery fulfilling the following criteria: 1) adoption of pharmacological prophylaxis, 2) performing of a bilateral venography before discharge, 3) interruption of pharmacological prophylaxis at discharge in patients with negative venography, and 4) post-discharge follow-up of the patients for at least four weeks. Out of 31 identified studies, 13 fulfilled the overview criteria. The total number of evaluated patients was 4120. An adequate venography was obtained in 3469 patients (84.1%). In the 2361 patients with negative venography (68.1%), 30 episodes of symptomatic venous thromboembolism after hospital discharge were reported with a resulting cumulative incidence of 1.27% (95% C.I. 0.82-1.72) and a weighted mean incidence of 1.52% (95% C.I. 1.05-1.95). Six cases of pulmonary embolism were reported. Our overview showed a low incidence of clinically overt venous thromboembolism at follow-up in major orthopaedic surgery patients discharged with negative venography. Extending pharmacological prophylaxis in these patients does not appear to be justified. Venous thrombi leading to hospital re-admission are likely to be present but asymptomatic at the time of discharge. Future research should be directed toward improving the accuracy of non invasive diagnostic methods in order to replace venography in the screening of asymptomatic post-operative deep vein thrombosis.

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Risk Factors for Bleeding during Treatment of Acute Venous Thromboembolism

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650643 ◽

1996 ◽

Vol 76 (05) ◽

pp. 682-688 ◽

Cited By ~ 33

Author(s):

Jos P J Wester ◽

Harold W de Valk ◽

Karel H Nieuwenhuis ◽

Catherine B Brouwer ◽

Yolanda van der Graaf ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Small Body ◽

Bleeding Risk ◽

Risk Scores ◽

Risk Of Bleeding ◽

Acute Venous Thromboembolism

Summary Objective: Identification of risk factors for bleeding and prospective evaluation of two bleeding risk scores in the treatment of acute venous thromboembolism. Design: Secondary analysis of a prospective, randomized, assessor-blind, multicenter clinical trial. Setting: One university and 2 regional teaching hospitals. Patients: 188 patients treated with heparin or danaparoid for acute venous thromboembolism. Measurements: The presenting clinical features, the doses of the drugs, and the anticoagulant responses were analyzed using univariate and multivariate logistic regression analysis in order to evaluate prognostic factors for bleeding. In addition, the recently developed Utrecht bleeding risk score and Landefeld bleeding risk index were evaluated prospectively. Results: Major bleeding occurred in 4 patients (2.1%) and minor bleeding in 101 patients (53.7%). For all (major and minor combined) bleeding, body surface area ≤2 m2 (odds ratio 2.3, 95% Cl 1.2-4.4; p = 0.01), and malignancy (odds ratio 2.4, 95% Cl 1.1-4.9; p = 0.02) were confirmed to be independent risk factors. An increased treatment-related risk of bleeding was observed in patients treated with high doses of heparin, independent of the concomitant activated partial thromboplastin time ratios. Both bleeding risk scores had low diagnostic value for bleeding in this sample of mainly minor bleeders. Conclusions: A small body surface area and malignancy were associated with a higher frequency of bleeding. The bleeding risk scores merely offer the clinician a general estimation of the risk of bleeding. In patients with a small body surface area or in patients with malignancy, it may be of interest to study whether limited dose reduction of the anticoagulant drug may cause less bleeding without affecting efficacy.

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Venous Thromboembolism and High Grade Gliomas

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649592 ◽

1993 ◽

Vol 70 (03) ◽

pp. 393-396 ◽

Cited By ~ 38

Author(s):

Mandeep S Dhami ◽

Robert D Bona ◽

John A Calogero ◽

Richard M Hellman

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Medical Center ◽

Significant Risk ◽

Bleeding Complications ◽

Fisher Exact Test ◽

High Grade ◽

Chi Square ◽

Exact Test ◽

High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

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