Venous Thromboembolism Events After Hip Arthroscopy: A Systematic Review

Objective: To determine the risk profile of venous thromboembolism (VTE) and evaluate VTE prophylaxis implementation of the hospitalized cancer patients in the DissolVE 2 study. Methods: The data of hospitalized cancer patients in the DissolVE 2 study were analyzed. The risk distribution of VTE, preventive measures and in-hospital VTE events of hospitalized patients with tumors were described by percentage and 95% confident interval (CI). Results: A total of 1 535 cancer patients were included. According to the Padua score, 826 (53.8%) patients were at low risk of VTE, while 709 (46.2%) patients were at high VTE risk. VTE events occurred in 4 low-risk patients (0.5%; 95%CI: 0.1%, 1.2%) and 5 high-risk patients (0.7%; 95%CI: 0.2%, 1.6%). The overall incidence was 0.6% (9/1 535, 95%CI: 0.3%, 1.1%). Among patients with high VTE risk, 666 (93.9%) did not receive any VTE prophylaxis, and only 11 (1.6%) patients received appropriate VTE prophylaxis. Among patients who received VTE prevention, no VTE event was observed. Conclusions: Nearly half of the hospitalized cancer patients are at high risk of VTE, but most of them don't receive VTE prophylaxis. The results reflect the insufficient management of VTE risk for hospitalized cancer patients in China, and improvement of awareness and practice of VTE prophylaxis is urgently needed.

Coagulopathy Does Not Protect Against Venous Thromboembolism in Hospitalized Patients With Chronic Liver Disease

Identification of prophylaxis and treatment for hospitalized patients associated with venous thromboembolism.

Did Patients with Renal Disease Receive Sufficient Prophylaxis for Venous Thromboembolism in the Real-World Settings?: A Study Among Hospitalized Acutely Medically Ill Patients

The Frequency of Venous Thromboembolism (VTE) Prophylaxis Among Patients Hospitalized for Cancer in the US

Hip arthroscopy is a commonly performed procedure in adolescents with hip pathology. However, there is limited data on venous thromboembolism (VTE) events in this population, resulting in minimal guidance on appropriate VTE prophylaxis, with the bulk of current guidance extrapolated from the adult population. Therefore, this study aims to assess overall rates of VTE in the adolescent population as well as compare these rates to a matched cohort of adult patients undergoing hip arthroscopy. This retrospective cohort study drew data from the TriNetX platform between January 1, 2003 and March 1, 2024. Adolescent patients, ages 13 to 18, were matched to adult patients (19 and older) undergoing hip arthroscopy, accounting for sex, tobacco use, oral contraceptive use, diabetes mellitus, and overweight/obesity. Outcomes of interest were deep vein thrombosis (DVT) or pulmonary embolism (PE) within 90 days after the procedure. Overall rates were calculated and compared between cohorts. Statistical significance was set at P <0.01. A total of 3655 patients were successfully matched with a mean age of 16 in the adolescent cohort and 35 in the adult cohort. The overall rates of DVT were similar between cohorts, at 1% for adolescent patients and 0.9% for adults (RR: 0.892; 95% CI: 0.559-1.423; P =0.63). All VTE events (combined DVT and PE) were also similar at 1.1% for adolescent patients and 1.0% in adults (RR: 0.925; 95% CI: 0.593-1.443; P =0.73). This study found no significant difference in VTE between adolescent and adult patients undergoing hip arthroscopy. The overall rate of VTE was relatively high in adolescent patients, at 1.1%, suggesting additional attention to VTE and potential chemoprophylaxis may be warranted in select patients. Level III-case-control study or retrospective cohort study.

Venous Thromboembolic Prophylaxis Following Treatment Initiation for Multiple Myeloma

While venous thromboembolism (VTE) risk assessment and prophylaxis is well established for medical and surgical in-patients, there is a paucity of evidence, and therefore guidelines, in this area for psychogeriatric in-patients. We wished to determine VTE incidence, risk, and use of prophylaxis, in a psychogeriatric in-patient population. Retrospective audit of consecutive psychogeriatric patients aged 65 years and over admitted to Bankstown Hospital over a 3-year period, 2007-2009. Using an adapted VTE risk scoring system, patients were assigned as low, medium, or high VTE risk. A total of 192 patients were included in the study. Mean age was 79.1 ± 7.0 years. Out of the total, 55.2% of patients had diagnosis of dementia, and 33.3% had depression. Overall, 81.8% (157/192) were assessed as low risk, and 18.2% (35/192) as medium risk. Also, 16.7% (32/192) received VTE prophylaxis. Four new VTE events occurred in medium-risk group, and one in low-risk group (p = 0.004). Overall VTE incidence was 10.5/10,000 patient-days, but 44.2 per 10,000 in medium-risk group. VTE risk score was predictive of VTE events - IRR 6.02 (95% Confidence Intervals (CI) = 1.76-20.7, p = 0.004) for every one-point increment in risk. Depression was associated with significantly higher VTE occurrence (6.3% in those with diagnosis vs. 0.8% without, p = 0.043). Using a VTE risk scoring system adapted for psychogeriatric in-patients, those assessed to be at medium risk had a significantly increased rate of VTE. On this basis, we would recommend VTE prophylaxis be prescribed for psychogeriatric in-patients assessed to be at medium and high level of risk.

Introduction: There is a high risk for venous thromboembolism (VTE) among patients hospitalized for acute ischemic stroke. Prophylactic anticoagulant therapy may reduce such risk. The aim of this study was to evaluate the receipt of VTE prophylaxis and VTE risk among patients hospitalized in the US for acute ischemic stroke. Methods: Patients hospitalized with acute ischemic stroke from 1/1/2012 to 6/30/2015 were identified from the MarketScan Commercial and Medicare databases. The first of such hospitalization to occur was defined as the index hospitalization. Patients were required to have continuous insurance coverage for the 6 months before (baseline period) and after (follow-up period) the index hospitalization. The proportion of patients who received VTE prophylaxis was determined. Additionally, Kaplan-Meier analysis was used to evaluate VTE risk following the index hospitalization. Results: Among patients hospitalized for acute ischemic stroke (n=1,148; mean age 69 years), 54.1% were female. During the index hospitalization, 48.4% (n=556) of patients received inpatient VTE prophylaxis. During the follow-up period, 15.9% (n=183) of patients received outpatient prophylaxis. Among these patients, 48.3% (n=554) did not receive any VTE prophylaxis and 12.6% (n=145) received both inpatient and outpatient VTE prophylaxis. Among this patient population, 1.1% (n=12) had a VTE event during the index hospitalization and 2.0% (n=23) had a VTE event after hospital discharge. The risk for VTE among such patients remained high for up to approximately 30-40 days after the index hospitalization (Figure). Conclusions: Despite a high risk for VTE, nearly half of patients hospitalized for acute ischemic stroke received no VTE prophylaxis therapy. Increased prophylaxis therapy may improve patient outcomes in this population.

Estimated Annual Number of Incident and Recurrent, Non-Fatal and Fatal Venous Thromboembolism (VTE) Events in the US.

To measure the per-event health plan costs for acute and follow-up treatment not directed by a clinical study protocol in a group of commercially insured patients in 2 managed care organizations following an incident hospitalization that included a diagnosis for a venous thromboembolism (VTE) event. A cohort of patients with an incident in-hospital VTE event, consisting of deep vein thrombosis (DVT), or pulmonary embolism (PE), or both DVT + PE, was retrospectively identified from the administrative claims databases of 2 large U.S. health care plans. Inclusion criteria were (a) an inpatient VTE event between January 1, 1998, and December 31, 2000, (b) no VTE diagnosis or anticoagulation therapy 3 months prior to the incident VTE in-hospital event, (c) at least 1 anticoagulation pharmacy fill following the incident hospital VTE, and (d) continuous health plan enrollment 3 months prior to and 6 months following the incident hospital VTE event. Total costs were reported on a per-event basis and consisted of the aggregated amount paid by the health plan to the provider after subtraction of member cost-share. Costs were collected separately, first for the incident VTE event for all patients identified and second for patients who had at least 1 of the following events in the follow-up period: bleed requiring or not requiring hospitalization, a recurrent VTE event requiring hospitalization, or a recurrent VTE and bleed (VTE + bleed) event requiring hospitalization. Costs were compared between incident diagnosis groups using multivariate generalized linear model techniques. A total of 2,147 patients (DVT=1,499 [69.8%], PE=373 [17.4%], DVT+PE= 275 [12.8%]) were identified (mean age=61.6standard deviation [SD] 16 years; 46.3% male) and were followed for an average of 21.3 (median, 19.2) months. Disease severity was high in these patients, including 59.2% with a history of or active malignancy. The prevalence of VTE was 2.04 per 100,000 study-eligible health plan members. For the incident VTE events, average costs were 7,712+/-18,339 US dollars (median, 3,131 US dollars) per incident DVT event; 9,566+/-13,512 US dollars (median, 6,424 US dollars) per PE incident event; and 12,200+/-24,038 US dollars (median, 6,678 US dollars) per incident DVT+PE event. Warfarin treatment following the incident VTE event was administered to 97.3% of patients for an average of 6.7 (median, 5.0) months at an average cost of 19.40 US dollars per patient per month. During the average period of 21.3 months, 534 patients (24.9%) experienced an average of 1.24 bleed or recurrent VTE events per patient that required hospitalization at a mean cost of 14,975 US dollars per event or 2,101 US dollars per patient per year. For patients with a bleed in the follow-up period that required hospitalization, average costs were 12,326+/-24,448 US dollars (median, 5,736 US dollars) per recurrent VTE; 15,339+/-52,029 US dollars (median, 4,999 US dollars) per bleed; or 24,085+/-65,411 US dollars (median, 10,185 US dollars) per recurrent VTE + bleed event. During the follow-up period, a total of 612 patients (28.5%) experienced 1,489 recurrent bleed events that did not require hospitalization, at an average cost of 239+/-386 US dollars (median, 95 US dollars) per event. There were no significant differences in mean total costs for all pair-wise comparisons between the 3 incident diagnosis groups. Of patients who experienced a VTE event during the incident hospital stay for any diagnosis, 1 in 4 experienced an average of 1.24 bleed or recurrent VTE events that required hospitalization in the 21 months of follow-up and incurred an average health plan cost of 14,957 US dollars per event. These data may be of interest to managed care decision makers when evaluating the cost impact of new therapies or providing more comprehensive anticoagulation management services for existing therapies.

Hematopoietic cell transplant (HCT) recipients are at risk for thromboembolic and bleeding complications. There is limited evidence regarding the optimal approach to managing venous thromboembolism (VTE) prophylaxis in hospitalized patients undergoing HCT. In this retrospective cohort study, we evaluated the incidence of bleeding and VTE events in hospitalized HCT patients who received VTE prophylaxis per our institution’s VTE Prophylaxis Protocol (VPP), with either enoxaparin 40 mg subcutaneously daily or heparin 5 000 units subcutaneously twice daily, compared to historical controls who did not receive VTE prophylaxis. The primary outcome was a composite of major bleeding events, clinically relevant non-major bleeding (CRNMB), and minor bleeding. The secondary outcome was a composite of VTE events. A total of 614 patients were evaluated, including 278 prior to and 336 after implementation of VPP. VTE prophylaxis resulted in no difference in bleeding events (15.1% in the pre-VPP group vs. 14.6% in the post-VPP group, p = 0.86) or composite of major and CRNMB events (0.72% vs. 0.30%, p = 0.59). There was a trend toward lower incidence of VTE events in the post-VPP group which did not reach statistical significance (8.6% vs. 6.0%, p = 0.20). We conclude that VTE prophylaxis does not pose additional bleeding risk in HCT patients.

Improving Compliance with Guidelines for Venous Thromboembolism (VTE) Prophylaxis Significantly Reduces VTE Events.

Incidence Rate of Venous Thromboembolism (VTE) and Utilization of a VTE Prophylaxis Orderset Module In Hospitalized Patients With Leukemia

A Novel Risk Assessment Model to Predict Venous Thromboembolism (VTE) in Cancer Inpatients: The Canclot Score