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Multicenter Study
. 2025 Apr;55(4):e14383.
doi: 10.1111/eci.14383. Epub 2025 Jan 16.

Care pathway for patients hospitalized with venous thromboembolism

Isabelle Mahé  1   2 , Yara Skaff  1 , Hélène Helfer  1 , Samuel Benarroch  1 , Florent Happe  1 , Adam Remaki  3 , Kankoe Sallah  4
Affiliations
Multicenter Study

Care pathway for patients hospitalized with venous thromboembolism

Isabelle Mahé et al. Eur J Clin Invest. 2025 Apr.

Abstract

Background: Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a potentially fatal disease with a multifactorial nature, impacting different medical and surgical specialties. Recently, new guidelines and direct oral anticoagulants facilitated early discharge for most DVT patients and non-severe PE patients.

Objective: The aim of this study is to illustrate the distribution of VTE patients throughout the hospital and map their care pathway from Emergency Department (ED) to hospital discharge.

Methods: This multicenter retrospective cross-sectional study included all hospitalized patients with a VTE code from 39 hospitals between 2018 and 2019. Data were analysed using JupyterLab, with subgroup analyses based on mode of entry, diagnosis location and thrombosis site.

Results: A total of 23,199 hospitalizations were analysed, involving 17,718 patients a median age 66 years [52-78] and man-to-women ratio 1.05. Among these, 10,747(46.3%) had PE and 4176(18.0%) had lower limb DVT. The ED was the primary entry point for 31.2% of cases, followed by gastroenterology, surgery, geriatrics, and internal medicine. Patients admitted through ED patients were most frequently transferred to internal medicine, cardiovascular and intensive care units (ICU). The median hospital stay was 9 days [4-21], with ICU stays being the longest (mean 15 days [8-27]). Notably, 1357 patients (18.8%) of VTE patients were discharged within 48 h of ED admission.

Conclusions: This study is the first to portray the distribution and care pathways of VTE patients across hospital departments. Despite recent clinical guidelines, many patients still require inpatient management, highlighting the need for dedicated care pathway.

Keywords: care pathways; epidemiology; thrombosis; venous thromboembolism.

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Conflict of interest statement

I. Mahé has received personal fees from Bristol Myers Squibb, LEO Pharma, Sanofi and Pfizer and non‐financial support from Bristol Myers Squibb, LEO Pharma and grants from BMS Pfizer and Leo Pharma. Other authors declare no conflict of interest. Authors have no conflicts of interest related to the study design or its results.

Figures

FIGURE 1
FIGURE 1
Identifying hospital stays with venous thromboembolism code in EDS.
FIGURE 2
FIGURE 2
Distribution of patients with the first reported venous thromboembolic event code according to the department during hospitalization. Surgery: general surgery, cardiothoracic surgery, neurosurgery, orthopaedics, ENT, plastic and reconstructive surgery and ophthalmology. *Internal medicine: general internal medicine, infectious disease, haematology, addiction and clinical immunology. Not specified: non‐identified Department. Other: dermatology, urology and palliative care unit.
FIGURE 3
FIGURE 3
Sankey diagram illustrating the first two displacements of VTE patients after being coded in the Emergency Department. *Other discharge: Patient transferred to another institution.
FIGURE 4
FIGURE 4
Sankey diagram illustrating the first two displacements of PE patients after being coded in the Emergency Department. *Other discharge: Patient transferred to another institution.
See this image and copyright information in PMC

References

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