Influence of the duration of hospital length of stay on frequency of prophylaxis and risk for venous thromboembolism among patients hospitalized for acute medical illnesses in the USA

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Abstract

Background: We evaluated whether the duration of hospital stay influences venous thromboembolism (VTE) prophylaxis patterns and VTE risk during hospitalization and post-discharge among patients hospitalized for acute illnesses in the USA.

Methods: Patients hospitalized for acute illnesses were identified from the US MarketScan Commercial and Medicare databases (January 1, 2012–June 30, 2015). Patients were stratified by index hospital length of stay (LOS), with study groups with 1–3 day, 4–6 day, and ≥7 day LOSs. Use of VTE prophylaxis and VTE event rates during and after hospitalization (6-month follow-up) were evaluated.

Results: Of the overall population, 8647 had a 1–3 day LOS, 5551 had a 4–6 day LOS, and 3697 had a ≥7 day LOS. A greater proportion of patients with a 1–3 day LOS (66.2%) did not receive any VTE prophylaxis in comparison to patients with a 4–6 day LOS (55.0%) and ≥7 day LOS (48.8%; p<0.001). Proportions of patients with VTE events during the index hospitalization increased with longer hospital LOS (1–3 day LOS: 0.5%; 4–6 day LOS: 1.3%; ≥7 day LOS: 5.4%), as did proportions of patients with VTE events during the 6-month follow-up (1–3 day LOS: 2.4%; 4–6 day LOS: 2.7%; ≥7 day LOS: 4.2%).

Conclusion: Among this study population of hospitalized acutely ill patients in the USA, VTE pharmacologic prophylaxis was underutilized, regardless of the duration of hospital stay. However, the risk for VTE events was substantial, with nearly 10% of those with a ≥7 day LOS having suffered a VTE event within 6 months.

Keywords: acute illness, hospitalization, venous thromboembolism, VTE prophylaxis, VTE risk.

Citation: Amin A, Neuman WR, Lingohr-Smith M, Menges B, Lin J. Influence of the duration of hospital length of stay on frequency of prophylaxis and risk for venous thromboembolism among patients hospitalized for acute medical illnesses in the USA. Drugs in Context 2019; 8: 212568. DOI: 10.7573/dic.212568

Contributions: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: Alpesh Amin is a research consultant and/or speaker for Novosys Health, Portola, BI, BMS, and Pfizer. Alpesh Amin did not receive funding for manuscript development. W Richey Neuman was an employee of Portola Pharmaceuticals at the time of this study. Melissa Lingohr-Smith, Brandy Menges, and Jay Lin are employees of Novosys Health. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at https://www.drugsincontext.com/wp-content/uploads/2019/01/dic.212568-COI.pdf

Acknowledgments: None.

Funding declaration: Novosys Health received research funds from Portola Pharmaceuticals in connection with conducting this study and for development of this manuscript.

Copyright: Copyright © 2019 Amin A, Neuman WR, Lingohr-Smith M, Menges B, Lin J. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2019 Amin A, Neuman WR, Lingohr-Smith M, Menges B, Lin J. https://doi.org/10.7573/dic.212568. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/influence-of-the-duration-of-hospital-length-of-stay-on-frequency-of-prophylaxis-and-risk-for-venous-thromboembolism-among-patients-hospitalized-for-acute-medical-illnesses-in-the-usa

Correspondence: Alpesh Amin, School of Medicine University of California, Irvine, UCIMC, 101 The City Drive South Building 58, Room 110, ZC-4076H, Mail Code: 4076, Irvine, CA 92868, USA. anamin@uci.edu

Provenance: submitted; externally peer reviewed.

Submitted: 22 October 2018; Peer review comments to author: 5 December 2018; Revised manuscript received: 13 December 2018; Accepted: 14 December 2018; Publication date: 21 January 2019.

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