Effect of a near-universal hospitalization-based prophylaxis regimen on annual number of venous thromboembolism events in the US

Abstract

• Approximately 500 000 US VTE events occur annually; approximately one-half are related to current or recent hospitalization.• VTE attack rates (2005)(2006)(2007)(2008)(2009)(2010) did not change despite nearuniversal in-hospital VTE prophylaxis, possibly due to short prophylaxis duration.The annual number of US venous thromboembolism (VTE) events, the number of potentially preventable events, and the effect of hospitalization-based prophylaxis are uncertain. We estimated VTE attack (incident plus recurrent VTE) rates and the total annual number of US VTE events related and unrelated to hospitalization using Rochester Epidemiology Project resources to identify all Olmsted County, Minnesota, residents with incident or recurrent VTE over the 6-year period 2005-2010. The average annual VTE attack rates related and unrelated to hospitalization were 282 and 8 per 10 000 person-years, respectively. The estimated average number of US VTE events was 495 669 per year (48% unrelated to hospitalization). Among Olmsted County residents hospitalized at a Mayo Clinic hospital from 2005 to 2010, the proportion of patients receiving VTE prophylaxis or with an indication that prophylaxis was unnecessary increased from ∼40% in 2005 to ∼90% by 2010. The annual age-and sex-adjusted hospitalization-related (in-hospital) VTE attack rates from 2005 to 2010 ranged from 251 to 306 (1155 to 1751) per 10 000 person-years (bed-years) and did not change significantly. The median durations of hospitalization and in-hospital prophylaxis were 3 days and 70 hours, respectively. A total of 75% of VTE events occurred after hospital discharge, with a 19.5-day median time to VTE. Additional efforts are needed to identify the individual inpatient and outpatient at high risk for incident and recurrent VTE and target (longer duration) primary and secondary prophylaxis to high-risk individuals who would benefit most. (Blood. 2017;130(2):109-114)

Idarucizumab for Dabigatran Reversal — Full Cohort Analysis

“…The 30-day mortality rate observed in this study is lower than the 30-day mortality rate of 50% observed among patients who were receiving warfarin and presented with intracranial hemorrhage and than the 30-day mortality rate of 30% observed among patients who were receiving warfarin and were about to undergo emergency intervention. [12][13][14][15][16][17] However, it is similar to the 30-day mortality rate of 15% observed among the first 67 patients enrolled in a study of andexanet for the reversal of factor Xa inhibitors in patients with serious bleeding. 18 The rate of thrombotic events was 4.8% at 30 days and 6.8% at 90 days, and the 30-day rate was similar in group A and group B (5.0% and 4.6%, respectively).…”

Current and future burden of venous thrombosis: Not simply predictable

“…For instance, guidelines now suggest extended or lifelong duration of anticoagulant therapy in men with a first unprovoked event, while previously, a limited treatment duration was recommended for these patients . Pulmonary embolism is now almost always diagnosed with computed tomography (CT) angiography or ventilation perfusion scan instead of (the gold standard) pulmonary angiography, and for several risk situations, such as surgery, near‐universal thromboprophylaxis strategies have been implemented . In addition, the prevalence of risk factors for venous thrombosis in populations is continuously changing.…”

Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients

“…Most VTE events (67%) occurred within 30 days of discharge; 20% of events occurred between 1 and 2 months, and 13% occurred between months 2 and 3 . A similar review among Olmsted County residents in Minnesota demonstrated that 75% of VTE events occurred after discharge, with a median time of 19.5 days . Data further supporting the risk of VTE beyond hospitalization come from an international registry of more than 11,000 patients that demonstrated the highest incidence of VTE occurred in the first 30 days after discharge (38%) …”

“…In the major trials supporting VTE prophylaxis in medically ill patients, the duration of prophylaxis was 6–14 days . Today, acutely ill medical patients are typically hospitalized for 3–5 days and do not routinely receive prophylaxis after discharge . Several observational trials demonstrated that risk of VTE extends beyond hospitalization .…”