Venous thrombosis risk during and after medical and surgical hospitalizations: The medical inpatient thrombosis and hemostasis (MITH) study

Ximena Jordan Bruno, Insu Koh, Pamela L. Lutsey, Robert F. Walker, Nicholas S. Roetker, Katherine Wilkinson, Nicolas L. Smith, Timothy B Plante, Allen B. Repp, Chris E. Holmes, Mary Cushman, Neil A Zakai

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Thirty to seventy percent of all venous thromboembolism (VTE) events are associated with hospitalization. The absolute and relative risks during and after hospitalization are poorly characterized. Objectives: Quantify the absolute rate and relative risk of VTE during and up to 3 months after medical and surgical hospitalizations. Patients/Methods: We conducted an observational cohort study between 2010 and 2016 of patients cared for by the University of Vermont (UVM) Health Network's primary care population. Cox proportional hazard models with hospitalization modeled as a time-varying covariate were used to estimate VTE risk. Results: Over 4.3 years of follow-up, 55 220 hospitalizations (156 per 1000 person-years) and 713 first venous thromboembolism events (2.0 per 1000 person-years) occurred. Among individuals not recently hospitalized, the rate of venous thromboembolism was 1.4 per 1000 person-years and 71.8 per 1000 person-years during hospitalization. During the first, second, and third months after discharge, the rates of venous thromboembolism were 35.1, 11.3, and 5.2 per 1000 person-years, respectively. Relative to those not recently hospitalized, the age- and sex-adjusted HRs of venous thromboembolism were 38.0 (95% CI 28.0, 51.5) during hospitalization, and 18.4 (95% CI 15.0, 22.6), 6.3 (95% CI 4.3, 9.0), and 3.0 (95% CI 1.7, 5.4) during the first, second, and third months after discharge, respectively. Stratified by medical versus surgical services the rates were similar. Conclusion: Hospitalization and up to 3 months after discharge were strongly associated with increased venous thromboembolism risk. These data quantify this risk for use in future studies.

Original languageEnglish (US)
Pages (from-to)1645-1652
Number of pages8
JournalJournal of Thrombosis and Haemostasis
Volume20
Issue number7
DOIs
StatePublished - Jul 2022

Bibliographical note

Funding Information:
This study was funded by grant R01‐HL141290 (N.A. Zakai) and R01‐HL131579 (P.L. Lutsey) from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA. The sponsor had no role in the analysis or interpretation of the data and the views presented in this manuscript do not necessarily reflect those of the sponsor. We appreciate and acknowledge the support and expertise of Mr. Michael Gianni, Senior Measurement Analyst and the Data Management Office at the University of Vermont Health Network.

Publisher Copyright:
© 2022 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.

Keywords

  • cohort studies
  • epidemiology
  • hospitalization
  • patient discharge
  • venous thromboembolism

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