Risk Factors for Venous Thromboembolism in Hospitalized Patients With Acute Medical Illness

Alikhan, Raza; Cohen, Alexander T.; Combe, S.; Samama, M; Desjardins, Louis; Eldor, Amiram; Janbon, C; Leizorovicz, Alain; Olsson, Carl; Turpie, Alexander G. G.

doi:10.1001/archinte.164.9.963

Cited by 429 publications

(355 citation statements)

References 26 publications

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“…Immobilization was not a specified variable in the study, but immobilizing conditions such as surgery, trauma, and recent hospitalization were included in the adjusted model 5. In a study of patients included in the MEDENOX‐study, originally investigating the impact of enoxaparin as thromboprophylaxis in hospitalized medical patients, acute infection was associated with a higher VTE‐risk (RR 1.47) compared to patients hospitalized with other pre‐defined medical conditions such heart failure and chronic obstructive pulmonary disease 21. However, the latter study did not address the impact of infection on risk of symptomatic VTE in hospitalized patients since the reference population also were at increased risk of VTE and most VTE events were asymptomatic due to bilateral examination by venography of the lower extremities of all participants.…”

Section: Discussionmentioning

confidence: 99%

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Grimnes

Isaksen

Tichelaar

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials There is a bidirectional relation between acute infections and immobilizationWe studied the impact of infection and immobilization on risk of VTE in a case‐crossover designAcute infection was a strong trigger for VTE independent of concomitant immobilizationInfection and immobilization had a synergistic effect on the VTE‐risk BackgroundA bidirectional relation exists between acute infection and immobilization, and both are triggers for venous thromboembolism (VTE). To what extent the association between infection and VTE‐risk is explained by immobilization is unknown.AimsTo investigate the impact of hospitalization with acute infection on the VTE‐risk in patients with and without concomitant immobilization, and to explore the differential impact of respiratory‐ (RTI) and urinary‐ (UTI) tract infections on the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).MethodsWe conducted a case‐crossover study of VTE‐patients (n = 707) recruited from a general population. Hospitalizations and VTE‐triggers were registered during the 90 days before a VTE (hazard period) and in four preceding 90‐day control periods. Conditional logistic regression was used to estimate odds ratios (ORs) for VTE according to triggers.ResultsAcute infection was registered in 267 (37.8%) of the hazard periods and in 107 (3.8%) of the control periods, corresponding to a high VTE‐risk after infection (OR 24.2, 95% CI 17.2‐34.0), that was attenuated to 15‐fold increased after adjustment for immobilization. The risk was 20‐fold increased after infection without concomitant immobilization, 73‐fold increased after immobilization without infection, and 141‐fold increased with the two combined. The risk of PE was apparently higher after RTIs (OR 48.3, 95% CI 19.4‐120.0) than UTIs (OR 12.6, 95% CI 6.4‐24.7), but diminished in sensitivity analyses excluding uncertain RTI diagnoses.ConclusionsOur findings suggest that hospitalization with infection is a strong VTE‐trigger also in non‐immobilized patients. Infection and immobilization had a synergistic effect on the VTE‐risk.

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Section: Discussionmentioning

confidence: 99%

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Grimnes

Isaksen

Tichelaar

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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“…In particular, patients with a primary diagnosis of COPD appeared not to share the same high risk of VTE as patients with the other diagnoses we examined, a finding reported by others. 11 The risk model we developed accurately stratifies patients across a wide range of VTE probabilities, but even among those with the highest predicted rates, symptomatic VTE occurred in less than 2%.…”

Section: Discussionmentioning

confidence: 99%

“…The ACCP recommendations cite just three studies of VTE risk factors in hospitalized medical patients. 11,17,18 Together they examined 477 cases and 1197 controls, identifying congestive heart failure, pneumonia, cancer, and previous VTE as risk factors.…”

Section: Discussionmentioning

confidence: 99%

Risk factor model to predict venous thromboembolism in hospitalized medical patients

Rothberg

Lindenauer

Lahti³

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:The Joint Commission requires that all medical inpatients be assessed for venous thromboembolism (VTE) risk, but available risk stratification tools have never been validated.METHODS:We conducted a retrospective cohort study of patients age ≥18 years, admitted to 374 US hospitals in 2004–2005, with a primary diagnosis of pneumonia, heart failure, chronic obstructive pulmonary disease (COPD), stroke, and urinary tract infection, and length of stay ≥3 days. Subjects were randomly assigned (80/20) to a derivation or validation set. We then assessed VTE (International Classification of Diseases, Ninth Revision [ICD‐9] code plus diagnostic test plus treatment), patient demographics, 21 potential risk factors, and other comorbidities. We created a VTE risk stratification tool using multivariable regression modeling and applied it to the validation sample.RESULTS:Of 242,738 patients, 612 (0.25%) patients fulfilled our criteria for VTE during hospitalization, and an additional 440 (0.18%) were readmitted for VTE within 30 days (overall incidence of 0.43%). In the multivariable model, age, sex, and 10 additional risk factors were associated with VTE. The strongest risk factors were inherited thrombophilia (OR 4.00), length of stay ≥6 days (OR 3.22), inflammatory bowel disease (OR 3.11), central venous catheter (OR 1.87), and cancer. In the validation set, the model had a c‐statistic of 0.75 (95% CI 0.71, 0.78). Deciles of predicted risk ranged from 0.11% to 1.46% with observed risk over the same deciles from 0.17% to 1.81%.CONCLUSIONS:The risk of symptomatic VTE in general medical patients is low. A risk factor model can identify those at sufficient risk to warrant pharmacologic prophylaxis. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.

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“…Many risk factors have been linked to the occurrence of venous thromboembolism (VTE) in the medically ill patients including increasing age, acute respiratory failure, congestive heart failure, cancer, acute infection, dehydration, rheumatologic disease, etc. [2,3].…”

Section: Introductionmentioning

confidence: 99%

Deep vein thrombosis in patients with advanced liver cirrhosis: a rare condition?

Lesmana

Inggriani²,

Cahyadinata³

et al. 2010

Hepatol Int

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Purpose Patients with liver cirrhosis are generally considered to be ''auto-anticoagulated'' because of coagulopathy and thrombocytopenia. However, deep vein thrombosis (DVT) has been reported in patients with liver cirrhosis. The objectives of this study were to know the prevalence of DVT among cirrhotic patients and to compare clinical pictures between cirrhotic patients with and without DVT. Methods A case-control study was performed on the basis of medical record data of patients with liver cirrhosis admitted between August 2004 and July 2007 in Medistra hospital in Jakarta. Diagnosis of DVT was established by duplex Doppler ultrasonography of the lower extremities. Patients with splanchnic thrombosis were excluded from this study. Diagnosis of liver cirrhosis was based on history and clinical manifestation, consistent with liver cirrhosis and confirmed by ultrasonography or computed tomography. Results A total of 256 patients with liver cirrhosis were included in this study; 164 (64.1%) among them were men. Patients' mean age was 60.5 ± 12.5 years, ranging from 16 to 88 years. Viral hepatitis accounted for 74.6% of patients with liver cirrhosis. DVT was found in 12 (4.7%)patients. There was no significant laboratory difference between cirrhotic patients with and without DVT (serum albumin, platelet count, aminotransferases, c-glutamyl transpeptidase, alkaline phosphatase, total bilirubin levels, and prothrombin time). Diabetes mellitus was significantly higher in the DVT group than that in the control group (66.6 vs. 34.0%, P = 0.025). Multivariate analysis confirmed diabetes mellitus as an independent risk factor for the occurrence of DVT (odds ratio = 4.26; 95% confidence interval = 1.206-15.034; P = 0.024). Conclusions The prevalence of DVT in patients with liver cirrhosis was 4.7%, and Deep vein thrombosis is not a rare condition in cirrhotic patients with coagulopathy and warrants further studies on the mechanisms and prevention.

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Risk Factors for Venous Thromboembolism in Hospitalized Patients With Acute Medical Illness

Abstract: Several independent risk factors for VTE were identified. These findings allow recognition of individuals at increased risk of VTE and will contribute to the formulation of an evidence-based risk assessment model for thromboprophylaxis in hospitalized general medical patients.

Cited by 429 publications

References 26 publications

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Risk factor model to predict venous thromboembolism in hospitalized medical patients

Deep vein thrombosis in patients with advanced liver cirrhosis: a rare condition?

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