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. 2012 May 1;125(17):2092-9.
doi: 10.1161/CIRCULATIONAHA.111.084467. Epub 2012 Apr 3.

Triggers of hospitalization for venous thromboembolism

Mary A M Rogers  1 , Deborah A Levine, Neil Blumberg, Scott A Flanders, Vineet Chopra, Kenneth M Langa
Affiliations

Triggers of hospitalization for venous thromboembolism

Mary A M Rogers et al. Circulation. .

Abstract

Background: The rate of hospitalization for venous thromboembolism (VTE) is increasing in the United States. Although predictors of hospital-acquired VTE are well-known, triggers of VTE before hospitalization are not as clearly defined. The objective of this study was to evaluate triggers of hospitalization for VTE.

Methods and results: A case-crossover study was conducted. Subjects were participants in the Health and Retirement Study, a nationally representative sample of older Americans. Data were linked to Medicare files for hospital and nursing home stays, emergency department visits, outpatient visits including physician visits, and home health visits from years 1991 to 2007 (n=16 781). The outcome was hospitalization for venous thromboembolism (n=399). Exposures during the 90-day period before hospitalization for VTE were compared with exposures occurring in 4 comparison periods. Infection was the most common trigger of hospitalization for VTE, occurring in 52.4% of the risk periods before hospitalization. The adjusted incidence rate ratios (IRRs; 95% confidence interval) were 2.90 (2.13, 3.94) for all infection, 2.63 (1.90, 3.63) for infection without a previous hospital or skilled nursing facility stay, and 6.92 (4.46, 10.72) for infection with a previous hospital or skilled nursing facility stay. Erythropoiesis-stimulating agents and blood transfusion were also associated with VTE hospitalization (IRR=9.33, 95% confidence interval: 1.19, 73.42; IRR=2.57, 95% confidence interval: 1.17, 5.64; respectively). Other predictors included major surgeries, fractures (IRR=2.81), immobility (IRR=4.23), and chemotherapy (IRR=5.70). These predictors, combined, accounted for a large proportion (69.7%) of exposures before VTE hospitalization as opposed to 35.3% in the comparison periods.

Conclusions: Risk prediction algorithms for VTE should be reevaluated to include infection, erythropoiesis-stimulating agents, and blood transfusion.

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Figures

Figure 1
Figure 1
Design of the Case-Crossover Study.
Figure 2
Figure 2
Use of Erythropoiesis Stimulating Agents by Time of Administration Prior to Hospitalization for Venous Thromboembolism
See this image and copyright information in PMC

Comment in

References

    1. Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000;83:416–420. - PubMed
    1. van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, Kramer MH, Kruip MJ, Kwakkel-van Erp JM, Leebeek FW, Nijkeuter M, Prins MH, Sohne M, Tick LW, Christopher Study Investigators Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172–179. - PubMed
    1. Spyropoulos AC, Anderson FA, Jr, Fitzgerald G, Decousus H, Pini M, Chong BH, Zotz RB, Bergmann JF, Tapson V, Froehlich JB, Monreal M, Merli GJ, Pavanello R, Turpie AG, Nakamura M, Piovella F, Kakkar AK, Spencer FA, IMPROVE Investigators Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest. 2011;140:706–714. - PubMed
    1. Healthcare Cost and Utilization Project (HCUP) HCUP Databases. Agency for Healthcare Research and Quality; Rockville, MD: [Accessed 11 November 2011]. www.hcup-us.ahrq.gov/nisoverview.jsp. - PubMed
    1. Mittleman MA, Mostofsky E. Physical, psychological and chemical triggers of acute cardiovascular events: preventive strategies. Circulation. 2011;124:346–354. - PMC - PubMed

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