PB1467 - Hospital-acquired (HA) versus post-discharge (PD) venous thromboembolism (VTE) similarities and differences: Analysis of the Medical Inpatient Thrombosis and Hemostasis (MITH) population

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Mansour Gergi, MD

Assistant Professor of Medicine
University of Vermont
Burlington, Vermont, United States

Co-Author(s)

Andrew D. Sparks, MS

Statistician
The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States
KW

Katherine S. Wilkinson, MS

Statistician
The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States
Ryan Thomas, MD

Hematology Fellow
Hematology/Oncology Division, Department of Medicine, The Larner College of Medicine at the University of Vermont
Essex Junction, Vermont, United States
NR

Nicholas Roetker

Epidemiologist
Chronic Disease Research Group, Hennepin Healthcare Research Institute
Minneapolis, Minnesota, United States
NS

Nicholas Smith

Epidemiologist
University of Washington
Seattle, Washington, United States
Neil A. Zakai, MD, MSc (he/him/his)

Professor
Hematology/Oncology Division, Department of Medicine, The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States

Background: Hospitalized medical patients are at elevated risk for VTE while in the hospital and after discharge. HA-VTE (occurring during hospitalization) and PD-VTE (occurring within 90 days after discharge) have interrelated but potentially different risk factors.

Aims: To examine similarities and differences of people with HA-VTE versus PD-VTE.

Methods: We identified all medical admissions resulting in HA-VTE or PD-VTE among people receiving care from University of Vermont Health Network primary care providers. We compared the counts of PD-VTE versus HA-VTE events across time windows from the date of admission (Figure 1). We then used age- and sex-adjusted logistic regression to examine risk factors for HA-VTE and PD-VTE, including reasons of admission, risk factors from a previously validated model for in-hospital VTE and two Elixhauser comorbidity indices (Table 2).

Results: Among 281 identified VTE events, 83 (30%) were HA-VTE and 198 (70%) were PD-VTE. Around a quarter of these events occurred from day 2 to day 4 after admission, when HA-VTE was more common than PD-VTE (61 vs 13). From day 5 onwards, PD-VTE was the predominant event type (Figure 1). People with HA-VTE and PD-VTE did not differ in terms of age, sex, or race. Hospital admissions were longer in patients with HA-VTE versus patients with PD-VTE (median of 11 versus 3). Admissions to cardiology were more common among patients with PD-VTE, while having an ICU stay, renal dysfunction, or anemia was more common among patients with HA-VTE. Patients with HA-VTE had higher scores for the Elixhauser comorbidity indices for mortality and readmission compared with patients with PD-VTE (Table 2).

Conclusion(s): Our analysis is the first to our knowledge to contrast people with HA-VTE versus PD-VTE and suggests that people with HA-VTE overall are sicker with higher comorbidity indices for mortality or readmission and potentially more complicated hospitalizations.