Subscribe to RSS
DOI: 10.1160/TH10-03-0169
Incidence and predictors of venous thromboembolism in post-acute care patients
A prospective cohort study Financial support:The study was partially supported by an unrestricted grant from AstraZeneca Italy, without involvement in study design, management, analysis and reporting.Publication History
Received:
10 March 2010
Accepted after major revision:
23 April 2010
Publication Date:
24 November 2017 (online)
Summary
Few studies have addressed the topic of venous thromboembolism (VTE) in patients hospitalised in rehabilitation facilities. This patient population is rapidly growing, and data aimed to better define VTE risk in this setting are needed. Primary aim of this prospective observational study was to evaluate the frequency of symptomatic, objectively confirmed VTE in a cohort of unselected consecutive patients admitted to rehabilitation facilities, after medical diseases or surgery. Further objectives were to assess overall mortality, to identify risk factors for VTE and mortality, and to assess the attitude of physicians towards thromboprophylaxis. A total of 3,039 patients were included in the study, and the median duration of hospitalisation was 26 days. Seventy-two patients (2.4%) had symptomatic VTE. The median time to VTE from admission to the long-term care unit was 13 days. According to multivariable analysis, previous VTE (hazard ratio 5.67, 95% confidence interval 3.30–9.77) and cancer (hazard ratio 2.26, 95% confidence interval 1.36–3.75) were significantly associated to the occurrence of VTE. Overall in-hospital mortality was 15.1%. Age over 75 years, male gender, disability, cancer, and the absence of thromboprophylaxis were significantly associated to an increased risk of death (multivariable analysis). In-hospital antithrombotic prophylaxis was administered to 75.1% of patients, and low-molecular-weight heparin was the most widely used agent. According to our study, patients admitted to rehabilitation facilities remain at substantially increased risk for VTE. Because this applies to the majority of these patients, there is a great need for clinical trials assessing optimal prophylactic strategies.
* A list of the participants in the TERSICORE Study Group is given at the end of the article.
-
References
- 1 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 381S-453S.
- 2 Bosson JL, Labarere J, Sevestre MA. et al. Deep vein thrombosis in elderly patients hospitalized in subacute care facilities: a multicenter cross-sectional study of risk factors, prophylaxis and prevalence. Arch Intern Med 2003; 163: 2613-2618.
- 3 Schianchi T, Meschi T, Briganti A. et al. Post-acute long stay and extensive rehabilitation: study of the first year of work at a long stay university hospital unit. Ann Ital Med Int 2001; 16: 32-37.
- 4 Roth HJ, Lovell L, Harvey RL. et al. Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke 2001; 32: 523-529.
- 5 Harvey RL, Lovell LL, Belanger N. et al. The effectiveness of anticoagulant and antiplatelet agents in preventing venous thromboembolism during stroke rehabilitation: a historical cohort study. Arch Phys Med Rehabil 2004; 85: 1070-1075.
- 6 Valderrama A, Del Castillo J, Diaz Granados CA. et al. Deep vein thrombosis in chronically bedridden elderly individuals. J Am Geriatr Soc 2006; 54: 866-867.
- 7 Sellier E, Labarere J, Bosson JL. et al. Effectiveness of a guideline for venous thromboembolism prophylaxis in elderly post-acute care patients: a multicenter study with systematic ultrasonographic examination. Arch Intern Med 2006; 166: 2065-2071.
- 8 Ambrosetti M, Salerno M, Zambelli M. et al. Deep vein thrombosis among patients entering cardiac rehabilitation after coronary artery bypass surgery. Chest 2004; 125: 191-196.
- 9 Sellier E, Labarere J, Sevestre MA. et al. Risk factors for deep vein thrombosis in older patients: a multicenter study with systematic compression ultrasonography in postacute care facilities in France. J Am Geriatr Soc 2008; 56: 224-230.
- 10 Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957; 2: 200-215.
- 11 Farrell B, Godwin J, Richards S. et al. The United Kingdom transient ischaemic at-tack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991; 54: 1044-1054.
- 12 Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3: 692-694.
- 13 Scannapieco G, Rossi M, Baldessin F. et al. Incidenza e fattori di rischio per tromboembolia venosa nei pazienti ricoverati in lungodegenza. Giorn Ital Med Int 2003; 2 (Suppl. 02) 101.
- 14 Agnelli G, Bolis G, Capussotti L. et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg 2006; 243: 89-95.
- 15 Gussoni G, Campanini M, Silingardi M. et al. In-hospital symptomatic venous thromboembolism and antithrombotic prophylaxis in Internal Medicine. Findings from a multicenter, prospective study. Thromb Haemost 2009; 101: 893-901.
- 16 Goldhaber SZ. Venous thromboembolism prophylaxis: quality, location (hospital vs home), and duration. Thromb Haemost 2009; 102: 1-2.
- 17 Kalka C, Spirk D, Siebenrock K-A. et al. Lack of extended venous thromboembolism prophylaxis in high-risk patients undergoing major orthopaedic or major cancer surgery. Electronic assessment of VTE prophylaxis in high-risk surgical patients at discharge from Swiss hospitals (ESSENTIAL). Thromb Haemost 2009; 102: 56-61.
- 18 Samama CM, Ravaud P, Parent F. et al. Epidemiology of venous thromboembolism after lower limb arthroplasty: the FOTO study. J Thromb Haemost 2007; 5: 2360-2367.