Venous Thromboembolism Prophylaxis and Risk for Acutely Medically Ill Patients Stratified by Different Ages and Renal Disease Status

Abstract

The objectives of this study were to examine venous thromboembolism (VTE) prophylaxis patterns and risk for VTE events during hospitalization and in the outpatient continuum of care among patients hospitalized for acute illnesses in the United States with stratification by different age groups and renal disease status. Acutely ill hospitalized patients were identified from the MarketScan databases (January 1, 2012-June 30, 2015) and grouped by age (<65, 65-74, ≥75 years old) and whether or not they had a baseline diagnosis of renal disease, separately. Of acutely ill hospitalized patients, 60.1% (n = 10 748) were <65 years old, 15.7% (n = 2803) were 65 to 74 years old, and 24.3% (n = 4344) were ≥75 years old; 32.9% (n = 5892) had baseline renal disease. Among the study cohorts, the majority of patients received no VTE prophylaxis regardless of age or baseline renal status (52.1%-63.6%). Rates of VTE during hospitalization and in the 6 months postdischarge were 4.7%, 4.6%, and 4.5% for patients <65, 65 to 74, and ≥75 years old, respectively, and 6.3% and 3.8% for patients with and without baseline renal disease. The risk for VTE was elevated for 30 to 40 days after index admission regardless of age and renal disease status.

Keywords: VTE prophylaxis; acute medical illness; elderly; hospitalized patients; inpatient and outpatient continuum of care; renal disease; venous thromboembolism.

Figure 1.

Proportions of hospitalized patients who received VTE prophylaxis in the inpatient and outpatient settings with (A) stratification by age-group and (B) stratification by baseline renal disease status. All P values <.001 for comparisons of cohorts stratified by age-group and cohorts stratified by baseline renal disease status. VTE indicates venous thromboembolism.

Figure 2.

Proportions of patients with VTE events during the index hospitalization and within 6 months of hospital discharge with (A) stratification by age group and (B) stratification by baseline renal disease status. P values are for comparisons of cohorts stratified by age-group and cohorts stratified by baseline renal disease status, separately. VTE indicates venous thromboembolism.

Figure 3.

Proportions* of VTE-related hospital readmissions in the follow-up period with (A) stratification by age-group and (B) stratification by baseline renal disease status. *These are percentages of all-cause hospital readmissions that were VTE related. P values are for comparisons of cohorts stratified by age-group and cohorts stratified by baseline renal disease status, separately. VTE indicates venous thromboembolism.

Figure 4.

Risk of VTE events (hazard function) by days after the index hospital admission date of the study population with stratification by age-group and baseline renal disease status. VTE indicates venous thromboembolism.