Venous thromboembolism in patients immobilized at home

Abstract

Introduction: The natural history of venous thromboembolism (VTE), its impact on outcome and the rationale for prophylaxis are well established for hospitalized acutely ill medical patients, but are less clear for non-hospitalized immobilized patients. Methods: We used the RIETE Registry database to compare the clinical characteristics, use of prophylaxis and 3-month outcome of all VTE patients with recent immobilization for ≥4 days according to being immobilized at home or in hospital. Results: Up to January 2014, 50764 patients with acute VTE were enrolled in RIETE. Of these, 9120 (18%) had recent immobility: 5960 (12%) at home, 2429 (4.8%) in hospital and 731 (1.4%) at a nursing home. Duration of immobility was longer than 4 weeks in 38% of patients at home and in 7.4% in hospital (OR: 7.64; 95% CI: 6.50-8.98), and the proportion of patients who had received VTE prophylaxis was 12% vs. 56%, respectively (OR: 0.11; 95% CI: 0.10-0.12). During the first 3 months of therapy, the rate of VTE recurrences (OR: 0.66; 95% CI: 0.48-0.92), major bleeding (OR: 0.69; 95% CI: 0.53-0.89), all-cause death (OR: 0.70; 95% CI: 0.61-0.80) and fatal bleeding (OR: 0.53; 95% CI: 0.32-0.87) were significantly lower in patients immobilized at home, but the mortality due to PE was similar (OR: 1.05; 95% CI: 0.74-1.49). Conclusions: the amount of patients arriving to the hospital with acute VTE after immobilization at home was over 2-fold higher than the amount of patients with VTE appearing during hospital stay. Those with an acute medical illness and those with renal insufficiency or cancer were at increased risk to die of PE, but only few had received prophylaxis.