OC 32.1 - Risk Factors for Venous Thrombosis after Discharge from Medical Hospitalizations: The Medical Inpatient Thrombosis and Hemostasis (MITH) Study

Monday, June 26, 2023

10:45 – 11:00 ET

Room: 710A

Session Available As: On-Demand

Presenting Author(s)

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

Co-Author(s)

KW

Katherine S. Wilkinson, MS

Statistician
The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States
Andrew D. Sparks, MS

Statistician
The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States
Mansour Gergi, MD

Assistant Professor of Medicine
University of Vermont
Burlington, Vermont, United States
Allen B. Repp, MD, MSc (he/him/his)

Professor
Department of Medicine, The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States
NR

Nicholas S. Roetker

Epidemiologist
Hennepin Healthcare Research Institute
Minneapolis, Minnesota, United States
NS

Nicholas L. Smith

Professor, Epidemiology
Department of Epidemiology, School of Public Health, University of Washington
Seattle, Washington, United States
PM

Preetika Muthukrishnan

Assistant Professor
Department of Medicine, The Larner College of Medicine at the University of Vermont
Burlington, Vermont, 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: Most studies on hospital-associated VTE do not include post-discharge events or only assess risk factors at hospital admission rather than discharge.

Aims: To identify risk factors for post-discharge VTE after a medical hospitalization.

Methods: We included patients who accessed primary care and discharged alive from a medical hospitalization at the University of Vermont Medical Center between January 2010 and September 2019. Patients were followed for inpatient and outpatient VTE events for up to 90 days after discharge. We estimated hazard ratios (HRs) of post-discharge VTE using age-, sex-, race-, and length of hospital stay-adjusted Cox models. Risk factors were derived from a validated risk model for in-hospital VTE and for the Elixhauser comorbidity indices, which were originally designed to predict comorbidity index measures (Table).

Results: Among 23,295 admissions, there were 198 post-discharge VTE events (incidence of 0.8%). The prevalence of risk factors and their associations with post-discharge VTE are shown in the Table. Malnutrition, longer hospital stays, but not age, sex, or race, were associated with increased risk of post-discharge VTE. Of previously identified in-hospital VTE risk factors, only history of VTE and active cancer were associated with increased risk of post-discharge VTE. Both the mortality and readmission Elixhauser Comorbidity Indices were associated with increased risk of post-discharge VTE.

Conclusion(s): Post-discharge VTE risk factors include characteristics related to the index hospitalization as well as patient specific risk factors. Hence post-discharge VTE risk assessment should not only include risk factors present at admission, but also those that can be assessed throughout the hospital stay.

Learning Objectives:

Upon completion, participant will be able to identify risk factors for post discharge venous thromboembolism
Upon completion, participant will be able to incorportate computable phenotypes into their own electronic health system to further research in the field
Upon completion, participant will be able to adapt their practice habits to minimize the risk of venous thromboembolism in high risk populations