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Pulmonary Vascular Disease |

Hospital-Acquired and Postdischarge Venous Thromboembolism (VTE) in Patients With Cancer Hospitalized for a Medical Illness: Analysis of Risk Factors and Effect on Survival

Timothy Fernandes*, MD; Beate Danielsen, PhD; Scott Kaatz, DO; Timothy Morris, MD; Richard White, MD
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University of California, San Diego, San Diego, CA


Chest. 2012;142(4_MeetingAbstracts):835A. doi:10.1378/chest.1387722
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Abstract

SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Although patients with cancer who develop acute VTE have decreased survival, it is not clear if this is true for all settings such as hospital-acquired VTE (HA-VTE) or post-discharge VTE. Risk factors for HA-VTE and post-discharge VTE in cancer patients have not been analyzed.

METHODS: We analyzed California hospital and emergency department discharge records (2005-2009) linked with the death registry. All cases had an active cancer and a hospital-stay >2 days. HA-VTE was defined using highly specific ICD-9-CM codes flagged as not present-on-admission. Post-discharge VTE was defined as readmission with a principal diagnosis of VTE <60 days after discharge. The outcomes of HA-VTE and post-discharge VTE were modeled using proportional hazard modeling. Potential risk-factors included demographic data, thrombotic risk and severity-of-illness (SOI, generated using 3M Software).

RESULTS: There were 331,471 cancer hospitalizations: 0.64% met criteria for HA-VTE and 1.04% had post-discharge VTE. Females, older age, and greater SOI were predictors of both HA-VTE and post-discharge VTE. The 180-day mortality for HA-VTE was 69.8% versus 49.8% for no HA-VTE (p<0.001). The 180-day mortality rate for post-discharge VTE cases was 59.0% versus 43.9% for those without VTE (p<0.001). The effect of post-discharge VTE on the risk of death was highest in cases with mild or moderate SOI at the time of discharge: odds-ratio for death <180 days was 3.3 (CI:2.4-4.4) for mild, 2.3 (CI:2.0-2.6) for moderate, 1.5 (CI:1.4-1.7) for major, and 1.3 (CI:1.0-1.6) for extreme SOI.

CONCLUSIONS: HA-VTE and post-discharge VTE were significant risk factors for decreased survival in cancer patients. Development of post-discharge VTE was associate with 2 to 3 fold higher odds of dying among patients who had mild or moderate SOI at the time of discharge; the effect of developing VTE was less pronounced in patients with major or extreme SOI.

CLINICAL IMPLICATIONS: Prevention of VTE in cancer patients is important because development of acute VTE is a risk factor for decreased survival. Further studies are needed to see if the benefits of post-discharge VTE prophylaxis outweigh the risks in cancer patients, particularly the patients with mild or moderate severity of illness. The benefits of thromboprophylaxis in patients with major or extreme SOI may be minimal.

DISCLOSURE: The following authors have nothing to disclose: Timothy Fernandes, Beate Danielsen, Scott Kaatz, Timothy Morris, Richard White

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University of California, San Diego, San Diego, CA

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