Abstract WP115: Venous Thromboembolism Readmission In Acute Ischemic Stroke

Abstract

Introduction: Venous thromboembolism (VTE) is a frequent and potentially life-threatening complication of acute ischemic stroke (AIS). We performed a nationwide analysis to evaluate rate and risk factors for VTE readmission in patients with AIS. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included adult patients with a principal discharge diagnosis of AIS from 2016 to 2018. AIS, pulmonary embolism, deep vein thrombosis and other diagnosis were identified based on standard ICD-10 CM codes. Patients who had VTE diagnosis during the index admission were excluded. We determined 90-day VTE readmission rates and trends in patients with a principal diagnosis of AIS stratified by 30-day epochs. We then constructed a stepwise binary logistic regression model to determine odds ratios (OR) of demographic and clinical factors associated with VTE readmission rates. Results: Of the 1,023,478 patients with AIS, 8378 (0.82%) had VTE during readmission and 2906 (0.28%) had VTE as principal diagnosis for readmission within 90 days of discharge. Among them, more than half (4557, 54.39% and 1581, 54.40%, respectively) of patients were readmitted within 30 days of discharge. The rate of VTE readmission decreased further away from index event (P < 0.001). In the Cox regression model, obesity (OR 1.48, 95% CI 1.24-1.76, P < 0.001), plegia of at least one limb (OR 1.24, 95% CI 1.08-1.43, P = 0.003), longer hospital length of stay (OR 1.02, 95% CI 1.01-1.02, P < 0.001), higher NIHSS (OR 1.04, 95% CI 1.03-1.05, P < 0.001) were associated with VTE readmission. Conversely, VTE readmission rates were lower in patients with a history of atrial fibrillation/flutter (OR 0.72, 95% CI 0.62-0.84, P < 0.001). Conclusion: Patients with obesity, paralysis, higher NIHSS score, or prolonged hospital length of stay are at higher risk for VTE readmission. AF strokes are less likely to have DVT/PE, perhaps due to anticoagulant use in such patients. Studies are needed to determine whether early mobilization and mechanical and/or chemical prophylaxis reduces VTE risk in high-risk patients.