Prevalence of Venous Thromboembolism Among Privately Insured US Adults

Boulet, Sheree L.

doi:10.1001/archinternmed.2010.336

Cited by 10 publications

(9 citation statements)

References 7 publications

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“…To minimize that problem, we first required the presence of either a pharmacy record for anticoagulant therapy or a relevant CPT code. These items were not found in 58% of patients with at least one outpatient VTE diagnosis code (results available upon request), similar to the 71% reduction previously reported for outpatient VTE private insurance claims [13]. More work is needed to refine the preliminary NLP algorithm and apply it to radiology records and to records without prophylaxis prescriptions.…”

Section: Discussionsupporting

confidence: 65%

“…However, limited variables and coding on these datasets restrict definitive confirmation of diagnoses, and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes contained in them are often not reliable [9–12]. In particular, the frequency of ICD-9 codes for DVT and PE in outpatient adult claims greatly exceeds validated rates of VTE [13]; in addition many patients with such claims have no record of treatment with anticoagulation or a relevant procedure [13,14]. …”

Section: Introductionmentioning

confidence: 99%

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Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

Nelson

Grosse

Waitzman

et al. 2015

Thrombosis Research

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Background There are limitations to using administrative data to identify postoperative venous thromboembolism (VTE). We used a novel approach to quantify postoperative VTE events among Department of Veterans Affairs (VA) surgical patients during 2005–2010. Methods We used VA administrative data to exclude patients with VTE during 12 months prior to surgery. We identified probable postoperative VTE events within 30 and 90 days post-surgery in three settings: 1) pre-discharge inpatient, using a VTE diagnosis code and a pharmacy record for anticoagulation; 2) post-discharge inpatient, using a VTE diagnosis code followed by a pharmacy record for anticoagulation within 7 days; and 3) outpatient, using a VTE diagnosis code and either anticoagulation or a therapeutic procedure code with natural language processing (NLP) to confirm acute VTE in clinical notes. Results Among 468,515 surgeries without prior VTE, probable VTEs were documented within 30 and 90 days in 3,931 (0.8%) and 5,904 (1.3%), respectively. Of probable VTEs within 30 or 90 days post-surgery, 47.8% and 62.9%, respectively, were diagnosed post-discharge. Among post-discharge VTE diagnoses, 86% resulted in a VA hospital readmission. Fewer than 25% of outpatient records with both VTE diagnoses and anticoagulation prescriptions were confirmed by NLP as acute VTE events. Conclusion More than half of postoperative VTE events were diagnosed post-discharge; analyses of surgical discharge records are inadequate to identify postoperative VTE. The NLP results demonstrate that the combination of VTE diagnoses and anticoagulation prescriptions in outpatient administrative records cannot be used to validly identify postoperative VTE events.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

Nelson

Grosse

Waitzman

et al. 2015

Thrombosis Research

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“…International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify cancer location and the presence of VTE (supplemental online Table 1) and bleeding (supplemental online Table 2). To reduce the effects of diagnostic imprecision associated with VTE diagnosis based on ICD-9-CM codes [17], the analyses of VTE incidence were performed using three different definitions. Definition A was an all-inclusive analysis comprising all individuals with an ICD-9-CM code relating to VTE who met the inclusion and exclusion criteria for the study (i.e., study period, tumor location).…”

Section: Data Source and Study Designmentioning

confidence: 99%

Venous Thromboembolism Risk in Patients With Cancer Receiving Chemotherapy: A Real-World Analysis

Lyman

Eckert

Wang³

et al. 2013

The Oncologist

167

102

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Introduction. The occurrence of malignant disease increases the risk for venous thromboembolism (VTE). Here we evaluate the risk for VTE in a large unselected cohort of patients with cancer receiving chemotherapy. Methods. The United States IMPACT health care claims database was retrospectively analyzed to identify patients with a range of solid tumors who started chemotherapy from January 2005 through December 2008. International Classification of Diseases, 9th revision, Clinical Modification Codes were used to identify cancer location, presence of VTE 3.5 months and 12 months after starting chemotherapy, and incidence of major bleeding complications. Health care costs were assessed one year before initiation of chemotherapy and one year after initiation of chemotherapy.Results. The overall incidence of VTE 3.5 months after starting chemotherapy was 7.3% (range 4.6%-11.6% across cancer locations) rising to 13.5% at 12 months (range 9.8%-21.3%). The highest VTE risk was identified in patients with pancreatic, stomach, and lung cancer. Patients in whom VTE developed had a higher risk for major bleeding at 3.5 months and at 12 months (11.0% and 19.8% vs. 3.8% and 9.6%, respectively). Health care costs were significantly higher in patients in whom VTE developed. Conclusion. Those undergoing chemotherapy as outpatients are at increased risk for VTE and for major bleeding complications. Thromboprophylaxis may be considered for such patients after carefully assessing the risks and benefits of treatment. The Oncologist 2013;18:1321-1329 Implications for Practice: This large observational study of unselected patients receiving cancer chemotherapy demonstrates considerably greater rates of venous thromboembolism (VTE) than commonly reported in patients accrued to clinical trials. The risk of VTE appears to increase progressively over the year following initiation of treatment. Cancer patients developing VTE also experience a greater risk of major bleeding and greater health care costs than patients without VTE. Patients considered at high risk for VTE should be considered for thromboprophylaxis after assessing the balance of potential benefits and harms.

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“…In the European Union, it is estimated that more than 1 million VTE events or VTE-related deaths occur annually (2); in the United States, VTE events requiring medical attention are estimated to occur at a rate of 400-500 cases per 100,000 persons per year (3,4). A 30% increase in prevalence has been observed in recent years as a result of the accumulating effects of an aging population combined with the increased risk of recurrent events and chronic sequelae after an episode of VTE has occurred.…”

mentioning

confidence: 99%

Endovascular Management of Deep Vein Thrombosis with Rheolytic Thrombectomy: Final Report of the Prospective Multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry

Garcia

Lookstein

Malhotra³

et al. 2015

Journal of Vascular and Interventional Radiology

138

102

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Prevalence of Venous Thromboembolism Among Privately Insured US Adults

Cited by 10 publications

References 7 publications

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

Venous Thromboembolism Risk in Patients With Cancer Receiving Chemotherapy: A Real-World Analysis

Endovascular Management of Deep Vein Thrombosis with Rheolytic Thrombectomy: Final Report of the Prospective Multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) Registry

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