OC 32.2 - Risk of Venous Thromboembolism and Major Bleeding in Patients with Acute Medical Illness Receiving Thromboprophylaxis with Enoxaparin

Monday, June 26, 2023

11:00 – 11:15 ET

Room: 710A

Session Available As: On-Demand

Presenting Author(s)

Gregoire Le Gal, MD PhD

MD, PhD
Ottawa Hospital Research Institute, University of Ottawa, Canada
Ottawa, Ontario, Canada

Co-Author(s)

Giancarlo Agnelli, MD

Professor
University of Perugia
Perugia, Umbria, Italy
HD

Harald Darius

MD
Vivantes Neukoelln Medical Center, Berlin, Germany
Berlin, Berlin, Germany
SK

Susan R. Kahn

MD, MSc
McGill University, Montreal, QC, Canada
Montreal, Quebec, Canada
TO

Tarek Owaidah

MD
King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh, Saudi Arabia
Riyadh, Ar Riyad, Saudi Arabia
AR

Ana Thereza C. Rocha

PROFESSOR OF MEDICINE/PULMONARY PHYSICIAN
Instituto Dor de Pesquisa e Ensino, Hospital Cardio Pulmonar, Salvador BA Brazil
SALVADOR, Bahia, Brazil
Olivier Sanchez, MD, PhD

Head of department
Université Paris Cité, Service de Pneumologie et Soins Intensifs, HEGP
Paris, France
ZZ

Zhenguo Zhai

MD, PhD
Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
Beijing, Beijing, China (People's Republic)
IK

Irfan Khan

PhD
Sanofi, US
Bridgewater, New Jersey, United States
YD

Yasmina Djoudi

MD
Sanofi, France
Paris, Ile-de-France, France
EP

Ekaterina Ponomareva

PhD
Axtria, Inc, Berkeley Heights, NJ, USA
Berkeley Heights, New Jersey, United States
AC

Alexander T. Cohen

MD
Guy's and St Thomas' NHS Foundation Trust, King's College London, UK
London, England, United Kingdom

Background: Guidelines recommend an individualized approach to venous thromboembolism (VTE) prophylaxis among hospitalized acutely ill medical patients. Assessment of the risk of VTE and major bleeding (MB) in this population is important for informing optimal prophylaxis.

Aims: To describe the risk and evaluate risk factors for VTE and MB in hospitalized acutely ill medical patients receiving thromboprophylaxis with enoxaparin.

Methods: Patients hospitalized for acute medical illness (conditions as per Table 1) between 2010 and 2019 who received enoxaparin prophylaxis were identified in the Optum database in the USA. Exclusion criteria were VTE, MB or surgery within the previous 90 days, and ongoing treatment with anticoagulation or dual antiplatelet therapy. Rates of symptomatic VTE and MB after enoxaparin initiation were estimated via the Kaplan-Meier (KM) method. VTE was defined as symptomatic event in inpatient or outpatient setting. MB was defined as bleeding in a critical area or organ or when bleeding was listed as the primary diagnosis of a hospital stay. Risk factors were identified via Cox proportional hazard model and included when statistically significant or deemed to be clinically relevant in multivariable analysis.

Results: 174,592 patients met selection criteria (median age 62). The incidences of VTE and MB at 90-days were 3.0% and 2.5%, respectively. Patients with cancer had the highest (5.4%) 90-day rate of VTE. Key risk factors for VTE were prior VTE (HR=8.06, 95%CI 7.55-8.60), cancer-related hospitalization (HR=2.08, 95%CI 1.93-2.24), and thrombophilia (HR=1.49, 95%CI 1.16-1.91). Key risk factors for bleeding were history of MB (HR=3.77, 95%CI 3.50-4.05), history of nonmajor bleeding (HR=2.25, CI 1.98-2.55) and hospitalization for ischemic stroke (HR=2.08, 95%CI 1.87-2.31).

Conclusion(s): There is substantial heterogeneity in the risk of VTE and MB in patients hospitalized for acute medical illness and initiated on enoxaparin. Risk stratification may help in identification of optimal strategies for pharmacologic prophylaxis in this population.

Learning Objectives:

understand determinantns of the risk-benefit balance of extended thromboprophylaxis in acutely ill medical patients
learn about the rates of thrombotic and bleeding complications observed in the Optum database of medical patients receiving enoxaparin
discuss implications of the heterogeneity in risks and how this could be the basis for future studies