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Semin Thromb Hemost 2025; 51(03): 301-311
DOI: 10.1055/s-0044-1791817
Review Article

Venous Thromboembolism after Hospital Discharge: Temporal Trends in Baseline Characteristics, Prevention, Treatment, and 90-day Outcomes

Benjamin Brenner
1   Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
2   The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
,
Inna Tzoran
1   Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
2   The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
,
Behnood Bikdeli
3   Cardiovascular Medicine Division and the Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
4   Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
5   Cardiovascular Research Foundation, New York, New York
,
Reina Valle
6   Department of Internal Medicine, Hospital Sierrallana, Santander, Spain
,
Géraldine Poenou
7   Department of Médecine et Thérapeutique, Hôpital Nord—CHU St-Etienne, Saint-Etienne, France
,
Raimundo Tirado-Miranda
8   Department of Internal Medicine, Hospital Infanta Margarita, Córdoba, Spain
,
María L. Pesce
9   Department of Internal Medicine, Hospital General Universitario de Elda, Alicante, Spain
,
Javier Pagán-Escribano
10   Department of Internal Medicine, Hospital General Universitario Morales Meseguer, Murcia, Spain
,
Matteo Giorgi-Pierfranceschi
11   Department of Internal Medicine, Istituti Ospitalieri di Cremona, Cremona, Italy
,
Manuel Monreal
12   Department of Internal Medicine, CIBER de Enfermedades Respiratorias, Madrid, Spain
13   Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM—Universidad Católica San Antonio de Murcia, Spain
,
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Abstract

Venous thromboembolism (VTE) after hospital discharge poses a serious health risk. Assessments of patient characteristics, prophylaxis, treatment, outcomes, and over time changes lack consistency. Data on 16,901 hospitalized patients in the Registro Informatizado Enfermedad TromboEmbolica registry (2003–2022) were analyzed to evaluate trends in baseline characteristics, prophylaxis, treatments, and 90-day outcomes among medical (6,218) and surgical (10,683) patient cohorts. Multivariable logistic regression was used to assess the risks of the composite of fatal pulmonary embolism (PE) or recurrent VTE and major bleeding. The proportion of patients who presented with PE increased among medical (from 54 to 72%) and surgical patients (from 55 to 58%). Prophylaxis use increased in medical patients (from 53 to 71%), while decreasing in surgical patients (from 67 to 58%). Notably, the 90-day composite of fatal PE or recurrent VTE decreased in medical (from 3.9 to 1.8%) and surgical patients (from 2.9 to 1.2%; p < 0.001 for both). Conversely, major bleeding increased (3.1 to 4.5%) in medical patients (p = 0.008), with no change in surgical patients (from 2.5 to 2.4%). Risk-adjusted analysis showed a yearly decrease in the risk for the composite outcome (subhazard ratio [sHR]: 0.95; 95% confidence interval [CI]: 0.93–0.98) in medical and surgical patients and an increase in the risk for major bleeding in medical patients only (sHR: 1.04; 95% CI: 1.01–1.07). Results were consistent after excluding coronavirus disease 2019 patients. Over 20 years, the composite of fatal PE or recurrent VTE within 90 days had significantly decreased in VTE patients after hospitalization for medical or surgical care. Medical patients, however, exhibited an increase in major bleeding.

Keywords

hospital-acquired VTE - medical patients - surgical patients - anticoagulation - bleeding

Authors' Contributions

B.B., I.T., B.B., and M.M. conceived and designed the study. B.B., I.T., B.B., R.V., G.P., R.T.M., M.L.P., J.P.E., M.G.P., and M.M. collected and/or interpreted the data. All authors revised the manuscript critically for important intellectual content and gave final approval of the manuscript submitted.


* A full list of the RIETE investigators is given in the [Appendix], available in online version only.


Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
17. Oktober 2024

© 2024. Thieme. All rights reserved.

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