PURPOSE: Despite the availability of national guidelines for venous thromboembolism (VTE) prophylaxis, the clinical and economic burden of VTE in the United States (US) remains high. This study assesses the real-world rate of VTE prophylaxis in medically ill inpatients and outpatients in the US, and identifies independent risk factors for VTE in this population.
METHODS: Data were extracted from PharMetrics database. Patients were included if they had a hospitalization claim, between January 2001 and December 2005, for cancer, congestive heart failure (CHF), severe infectious disease (SID), or lung disease; and were aged ≥40 years. Discharges with <12 months of complete records prior to the index hospitalization claim date were excluded. VTE rate, VTE type, and time to VTE were calculated and compared between diagnoses groups. Independent predictors of VTE occurrence were also investigated using logistic regression analysis.
RESULTS: A total of 158,325 patients met the study criteria. CHF patients received the highest level of prophylaxis (13.1%), with less than 5% of patients in each of the remaining groups receiving prophylaxis. The total incidence of VTE was 5.6%, with the highest incidence occurring in the cancer patients (7.6%). Overall, the median time to VTE was 74 days, with the shortest time observed in the SID patients (62 days) and the longest time in the CHF patients (126 days). Independent predictors of VTE were: a pre-index VTE (odds ratio [OR] 9.06, 95% confidence interval [CI] 8.28–9.91), a primary diagnosis of cancer compared with a diagnosis of SID (OR 1.34, 95% CI 1.24–1.46), increased length of index hospitalization (OR 1.04, 95% CI 1.03–1.04), and having a higher pre-index Charlson comorbidity score (OR 1.03, 95% CI 1.01–1.04).
CONCLUSION: US commercially insured medical patients are not only at risk of VTE during hospitalization, but remain at risk post-discharge.
CLINICAL IMPLICATIONS: Initiatives from the Joint Commission are under way to address this issue in hospitalized patients, with the aim of reducing the clinical and economic burden of VTE.
DISCLOSURE: Alex Spyropoulos, Grant monies (from industry related sources) David Battleman, Mohamed Hussein - employees of IMS Health which received funding to perform the analysis from sanofi-aventis US, Inc.; Employee Jay Lin - employee sanofi-aventis, US Inc.; Consultant fee, speaker bureau, advisory committee, etc. Alex Spyropoulos - consultant to sanofi-aventis, boehringer-ingelheim; speakers bureau for Eisai Inc.; Other Financial and editorial support for this publication was provided by sanofi-aventis US, Inc.; No Product/Research Disclosure Information