Document Detail


Triggers of hospitalization for venous thromboembolism.
MedLine Citation:
PMID:  22474264     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The rate of hospitalization for venous thromboembolism (VTE) is increasing in the United States. Although predictors of hospital-acquired VTE are well-known, triggers of VTE before hospitalization are not as clearly defined. The objective of this study was to evaluate triggers of hospitalization for VTE.
METHODS AND RESULTS: A case-crossover study was conducted. Subjects were participants in the Health and Retirement Study, a nationally representative sample of older Americans. Data were linked to Medicare files for hospital and nursing home stays, emergency department visits, outpatient visits including physician visits, and home health visits from years 1991 to 2007 (n=16 781). The outcome was hospitalization for venous thromboembolism (n=399). Exposures during the 90-day period before hospitalization for VTE were compared with exposures occurring in 4 comparison periods. Infection was the most common trigger of hospitalization for VTE, occurring in 52.4% of the risk periods before hospitalization. The adjusted incidence rate ratios (IRRs; 95% confidence interval) were 2.90 (2.13, 3.94) for all infection, 2.63 (1.90, 3.63) for infection without a previous hospital or skilled nursing facility stay, and 6.92 (4.46, 10.72) for infection with a previous hospital or skilled nursing facility stay. Erythropoiesis-stimulating agents and blood transfusion were also associated with VTE hospitalization (IRR=9.33, 95% confidence interval: 1.19, 73.42; IRR=2.57, 95% confidence interval: 1.17, 5.64; respectively). Other predictors included major surgeries, fractures (IRR=2.81), immobility (IRR=4.23), and chemotherapy (IRR=5.70). These predictors, combined, accounted for a large proportion (69.7%) of exposures before VTE hospitalization as opposed to 35.3% in the comparison periods.
CONCLUSIONS: Risk prediction algorithms for VTE should be reevaluated to include infection, erythropoiesis-stimulating agents, and blood transfusion.
Authors:
Mary A M Rogers; Deborah A Levine; Neil Blumberg; Scott A Flanders; Vineet Chopra; Kenneth M Langa
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-04-03
Journal Detail:
Title:  Circulation     Volume:  125     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-01     Completed Date:  2012-07-17     Revised Date:  2013-05-03    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2092-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, 48109-5429, USA. maryroge@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Ambulatory Care Facilities / statistics & numerical data
Blood Transfusion / adverse effects
Comorbidity
Cross-Over Studies
Emergency Service, Hospital / statistics & numerical data
Female
Hematinics / adverse effects,  therapeutic use
Home Care Services / statistics & numerical data
Hospitalization / statistics & numerical data*
Humans
Immobilization / adverse effects
Incidence
Infection / epidemiology
Male
Medicare / statistics & numerical data
Middle Aged
Office Visits / statistics & numerical data
Postoperative Complications / epidemiology
Pulmonary Embolism / epidemiology*
Risk Factors
Skilled Nursing Facilities / statistics & numerical data
United States / epidemiology
Venous Thrombosis / epidemiology*
Grant Support
ID/Acronym/Agency:
5R21HL093129-02/HL/NHLBI NIH HHS; R01 HL095467/HL/NHLBI NIH HHS; R01 HL095467/HL/NHLBI NIH HHS; R21 HL093129-01A1/HL/NHLBI NIH HHS; R21 HL093129-02/HL/NHLBI NIH HHS; U01AG009740/AG/NIA NIH HHS
Chemical
Reg. No./Substance:
0/Hematinics
Comments/Corrections
Comment In:
Circulation. 2012 May 1;125(17):2051-3   [PMID:  22474263 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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