Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

Abstract

Importance: While hospital-associated venous thromboembolism (HA-VTE) is a known complication of hospitalization, contemporary incidence and outcomes data are scarce and methodologically contested.

Objective: To define and validate an automated electronic health record (EHR)-based algorithm for retrospective detection of HA-VTE and examine contemporary HA-VTE incidence, previously reported risk factors, and outcomes.

Design, setting, and participants: This cohort study was conducted using hospital admissions between January 1, 2013, and June 30, 2021, with follow-up until December 31, 2021. All medical (non-intensive care unit) admissions at an integrated health care delivery system with 21 hospitals in Northern California during the study period were included. Data were analyzed from January to June 2022.

Exposures: Previously reported risk factors associated with HA-VTE and administration of pharmacological prophylaxis were evaluated as factors associated with HA-VTE.

Main outcomes and measures: Yearly incidence rates and timing of HA-VTE events overall and by subtype (deep vein thrombosis, pulmonary embolism, both, or unknown), as well as readmissions and mortality rates.

Results: Among 1 112 014 hospitalizations involving 529 492 patients (268 797 [50.8%] women; 75 238 Asian [14.2%], 52 697 Black [10.0%], 79 398 Hispanic [15.0%], and 307 439 non-Hispanic White [58.1%]; median [IQR] age, 67.0 [54.0-79.0] years), there were 13 843 HA-VTE events (1.2% of admissions) occurring in 10 410 patients (2.0%). HA-VTE events increased from 307 of 29 095 hospitalizations (1.1%) in the first quarter of 2013 to 551 of 33 729 hospitalizations (1.6%) in the first quarter of 2021. Among all HA-VTE events, 10 746 events (77.6%) were first noted after discharge. In multivariable analyses, several factors were associated with increased odds of HA-VTE, including active cancer (adjusted odds ratio [aOR], 1.96; 95% CI, 1.85-2.08), prior VTE (aOR, 1.71; 95% CI, 1.63-1.79), and reduced mobility (aOR, 1.63; 95% CI, 1.50-1.77). Factors associated with decreased likelihood of HA-VTE included Asian race (vs non-Hispanic White: aOR, 0.65; 95% CI, 0.61-0.69), current admission for suspected stroke (aOR, 0.73; 95% CI, 0.65-0.81), and Hispanic ethnicity (vs non-Hispanic White: aOR, 0.81; 95% CI, 0.77-0.86). HA-VTE events were associated with increased risk of readmission (hazard ratio [HR], 3.33; 95% CI, 3.25-3.41) and mortality (HR, 1.63; 95% CI, 1.57-1.70).

Conclusions and relevance: This study found that HA-VTE events occurred in 1.2% of medical admissions, increased over time, and were associated with increased adverse outcomes. These findings suggest that approaches designed to mitigate occurrence and outcomes associated with HA-VTE may remain needed.

Figure 1.. Incidence Rates Over Time

The incidence of hospital-associated venous thromboembolism (HA-VTE) is given as the percentage of all included admissions. HA-DVT indicates hospital-associated deep vein thrombosis; HA-PE, hospital-associated pulmonary embolism; Q, quarter.

Figure 2.. Time Course of Events During Admission

The time course of hospital-associated venous thromboembolism (HA-VTE) events that happened during the index admission, with events censored at time of event or hospital discharge, is presented. Day 30 on the x-axis includes all hospitalizations lasting 30 or more days (5980 of 1 112 014 hospitalizations [0.5%]).

Figure 3.. Time Course of Events After Discharge

The time course of hospital-associated venous thromboembolism (HA-VTE) events that happened after discharge from the index admission, with events censored at 90 days after hospital discharge, is presented.

Figure 4.. Mortality and Readmission Rates

Kaplan-Meier survival curves among patients with and without hospital-associated venous thromboembolism (HA-VTE) events are presented for A, mortality (day 0 is day of admission) and B, readmissions (day 0 is day of discharge). HA-DVT indicates hospital-associated deep vein thrombosis; HA-PE, hospital-associated pulmonary embolism.