Identification of residual risk factors for the development of venous thromboembolism in medical inpatients receiving subcutaneous heparin therapy for prophylaxis

Shumei Kato, Yuichi J. Shimada, Patricia Friedmann, Glenn Kashan, Gregg Husk, Steven R. Bergmann

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVES: Venous thromboembolism (VTE) such as pulmonary embolism and deep venous thrombosis is the most common cause of preventable morbidity and mortality in hospitalized patients. Prophylaxis is recommended for medical patients older than 40 years with at least one risk factor. However, the currently recommended regimen prevents only about half of in-hospital VTE. The aim of this study was to identify the risk factors for development of VTE in medical inpatients who were already on recommended pharmacological prophylaxis. METHODS: We performed a retrospective cohort study of 10 633 patients who were admitted to the medicine service and received prophylaxis with subcutaneous unfractionated heparin. The diagnoses of pulmonary embolism and deep venous thrombosis were confirmed with computed tomography angiography and Doppler ultrasound, respectively. Univariate analysis with the χ-test, followed by log-linear Poisson regression analysis was performed to determine the relative risk associated with each factor. RESULTS: Sixty cases of in-hospital VTE [raw incidence, 0.6%; 95% confidence interval (0.43-0.72)] were observed. On univariate analysis, a previous history of VTE or an active malignancy were found to be significant residual risk factors for the development of in-hospital VTE. On multivariate analysis, only a previous history of VTE remained a significant independent risk factor [relative risk=30.1; 95% confidence interval (17.1-53.0); P<0.0001]. CONCLUSION: Among hospitalized patients admitted to the medicine service and receiving VTE prophylaxis with subcutaneous unfractionated heparin, those with a previous history of VTE were at a significant risk of developing in-hospital VTE. This at-risk population should be considered for more aggressive therapy to prevent recurrent VTE.

Original languageEnglish (US)
Pages (from-to)294-297
Number of pages4
JournalCoronary Artery Disease
Volume23
Issue number4
DOIs
StatePublished - Jun 2012

Fingerprint

Venous Thromboembolism
Heparin
Inpatients
Therapeutics
Pulmonary Embolism
Venous Thrombosis
Medicine
Confidence Intervals
Doppler Ultrasonography
Linear Models
Cohort Studies
Multivariate Analysis
Retrospective Studies
Regression Analysis
Pharmacology
Morbidity

Keywords

  • deep vein thrombosis
  • prophylaxis
  • pulmonary embolism
  • unfractionated heparin
  • venous thromboembolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Identification of residual risk factors for the development of venous thromboembolism in medical inpatients receiving subcutaneous heparin therapy for prophylaxis. / Kato, Shumei; Shimada, Yuichi J.; Friedmann, Patricia; Kashan, Glenn; Husk, Gregg; Bergmann, Steven R.

In: Coronary Artery Disease, Vol. 23, No. 4, 06.2012, p. 294-297.

Research output: Contribution to journalArticle

@article{387e00d4d7634e77a3daf1b26953b924,
title = "Identification of residual risk factors for the development of venous thromboembolism in medical inpatients receiving subcutaneous heparin therapy for prophylaxis",
abstract = "OBJECTIVES: Venous thromboembolism (VTE) such as pulmonary embolism and deep venous thrombosis is the most common cause of preventable morbidity and mortality in hospitalized patients. Prophylaxis is recommended for medical patients older than 40 years with at least one risk factor. However, the currently recommended regimen prevents only about half of in-hospital VTE. The aim of this study was to identify the risk factors for development of VTE in medical inpatients who were already on recommended pharmacological prophylaxis. METHODS: We performed a retrospective cohort study of 10 633 patients who were admitted to the medicine service and received prophylaxis with subcutaneous unfractionated heparin. The diagnoses of pulmonary embolism and deep venous thrombosis were confirmed with computed tomography angiography and Doppler ultrasound, respectively. Univariate analysis with the χ-test, followed by log-linear Poisson regression analysis was performed to determine the relative risk associated with each factor. RESULTS: Sixty cases of in-hospital VTE [raw incidence, 0.6{\%}; 95{\%} confidence interval (0.43-0.72)] were observed. On univariate analysis, a previous history of VTE or an active malignancy were found to be significant residual risk factors for the development of in-hospital VTE. On multivariate analysis, only a previous history of VTE remained a significant independent risk factor [relative risk=30.1; 95{\%} confidence interval (17.1-53.0); P<0.0001]. CONCLUSION: Among hospitalized patients admitted to the medicine service and receiving VTE prophylaxis with subcutaneous unfractionated heparin, those with a previous history of VTE were at a significant risk of developing in-hospital VTE. This at-risk population should be considered for more aggressive therapy to prevent recurrent VTE.",
keywords = "deep vein thrombosis, prophylaxis, pulmonary embolism, unfractionated heparin, venous thromboembolism",
author = "Shumei Kato and Shimada, {Yuichi J.} and Patricia Friedmann and Glenn Kashan and Gregg Husk and Bergmann, {Steven R.}",
year = "2012",
month = "6",
doi = "10.1097/MCA.0b013e328352e510",
language = "English (US)",
volume = "23",
pages = "294--297",
journal = "Coronary Artery Disease",
issn = "0954-6928",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Identification of residual risk factors for the development of venous thromboembolism in medical inpatients receiving subcutaneous heparin therapy for prophylaxis

AU - Kato, Shumei

AU - Shimada, Yuichi J.

AU - Friedmann, Patricia

AU - Kashan, Glenn

AU - Husk, Gregg

AU - Bergmann, Steven R.

PY - 2012/6

Y1 - 2012/6

N2 - OBJECTIVES: Venous thromboembolism (VTE) such as pulmonary embolism and deep venous thrombosis is the most common cause of preventable morbidity and mortality in hospitalized patients. Prophylaxis is recommended for medical patients older than 40 years with at least one risk factor. However, the currently recommended regimen prevents only about half of in-hospital VTE. The aim of this study was to identify the risk factors for development of VTE in medical inpatients who were already on recommended pharmacological prophylaxis. METHODS: We performed a retrospective cohort study of 10 633 patients who were admitted to the medicine service and received prophylaxis with subcutaneous unfractionated heparin. The diagnoses of pulmonary embolism and deep venous thrombosis were confirmed with computed tomography angiography and Doppler ultrasound, respectively. Univariate analysis with the χ-test, followed by log-linear Poisson regression analysis was performed to determine the relative risk associated with each factor. RESULTS: Sixty cases of in-hospital VTE [raw incidence, 0.6%; 95% confidence interval (0.43-0.72)] were observed. On univariate analysis, a previous history of VTE or an active malignancy were found to be significant residual risk factors for the development of in-hospital VTE. On multivariate analysis, only a previous history of VTE remained a significant independent risk factor [relative risk=30.1; 95% confidence interval (17.1-53.0); P<0.0001]. CONCLUSION: Among hospitalized patients admitted to the medicine service and receiving VTE prophylaxis with subcutaneous unfractionated heparin, those with a previous history of VTE were at a significant risk of developing in-hospital VTE. This at-risk population should be considered for more aggressive therapy to prevent recurrent VTE.

AB - OBJECTIVES: Venous thromboembolism (VTE) such as pulmonary embolism and deep venous thrombosis is the most common cause of preventable morbidity and mortality in hospitalized patients. Prophylaxis is recommended for medical patients older than 40 years with at least one risk factor. However, the currently recommended regimen prevents only about half of in-hospital VTE. The aim of this study was to identify the risk factors for development of VTE in medical inpatients who were already on recommended pharmacological prophylaxis. METHODS: We performed a retrospective cohort study of 10 633 patients who were admitted to the medicine service and received prophylaxis with subcutaneous unfractionated heparin. The diagnoses of pulmonary embolism and deep venous thrombosis were confirmed with computed tomography angiography and Doppler ultrasound, respectively. Univariate analysis with the χ-test, followed by log-linear Poisson regression analysis was performed to determine the relative risk associated with each factor. RESULTS: Sixty cases of in-hospital VTE [raw incidence, 0.6%; 95% confidence interval (0.43-0.72)] were observed. On univariate analysis, a previous history of VTE or an active malignancy were found to be significant residual risk factors for the development of in-hospital VTE. On multivariate analysis, only a previous history of VTE remained a significant independent risk factor [relative risk=30.1; 95% confidence interval (17.1-53.0); P<0.0001]. CONCLUSION: Among hospitalized patients admitted to the medicine service and receiving VTE prophylaxis with subcutaneous unfractionated heparin, those with a previous history of VTE were at a significant risk of developing in-hospital VTE. This at-risk population should be considered for more aggressive therapy to prevent recurrent VTE.

KW - deep vein thrombosis

KW - prophylaxis

KW - pulmonary embolism

KW - unfractionated heparin

KW - venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=84860835290&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860835290&partnerID=8YFLogxK

U2 - 10.1097/MCA.0b013e328352e510

DO - 10.1097/MCA.0b013e328352e510

M3 - Article

VL - 23

SP - 294

EP - 297

JO - Coronary Artery Disease

JF - Coronary Artery Disease

SN - 0954-6928

IS - 4

ER -