Rethinking Guidelines for VTE Risk Among Nursing Home Residents

Leibson, Cynthia L.; Petterson, Tanya M.; Smith, Carin Y.; Bailey, Kent R.; Emerson, Jane A.; Ashrani, Aneel A.; Takahashi, Paul Y.; Heit, John A.

doi:10.1378/chest.13-2652

Cited by 10 publications

(6 citation statements)

References 35 publications

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“…Reduced physical activity leads to stasis or slow blood flow, which in turn allows small clots to gradually fuse and form larger blood clots. Many studies have confirmed the relationship between long-term inactivity and DVT ( 16 - 19 ). In particular, Apenteng et al ’s prospective cohort study demonstrated that in the same population, the incidence of VTE was obviously higher in long-term bedridden people than in old people who were able to act on their own in care homes ( 17 ).…”

Section: Discussionmentioning

confidence: 94%

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Dong¹,

Tong²,

Wang³

et al. 2023

Transl Lung Cancer Res

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Background There is growing evidence that misdiagnosis contributes to the high mortality rate in lung cancer patients complicated with pulmonary embolism (PE). This current study analyzed predictors of PE in lung cancer patients with lower extremity deep venous thrombosis (DVT) with the aim of personalizing the treatment and management of patients with PE. Methods This retrospective case-control study included lung cancer patients with DVT at the emergency department of Shanghai Chest Hospital from January 2018 to December 2019. Patients were classified as having DVT with or without PE. The following characteristics were examined, including age, gender, smoking, hypertension, surgical trauma, hyperlipidemia, long-term bedridden status, calf swelling, coronary heart disease, chronic pulmonary disease, DVT location, DVT type, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, and D-dimer, and univariate and multivariate analyses were performed. Results A total of 90 patients with lung cancer and DVT were analyzed, of whom 60% (54/90) had PE. Those variables independently associated to PE were hypertension [odds ratio (OR): 7.883, 95% confidence interval (CI): 2.038–30.495, P=0.003], long-term bedridden status (OR: 4.166, 95% CI: 1.236–14.044, P=0.021), and D-dimer levels (OR: 2.123, 95% CI: 1.476–3.053, P=0.000) were identified as independent risk factors for PE. The cut-off value of the receiver operating characteristic (ROC) curve for predicting PE by presented scoring system according to the risk factors was 1.5 and the area under the curve (AUC) was 0.84 (P<0.001). Conclusions Hypertension, being bedridden for an extended period, and elevated serum D-dimer levels were independent risk factors of PE in lung cancer patients with lower extremity DVT. Novel strategies for patient management should be developed to decrease the risk of PE.

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Section: Discussionmentioning

confidence: 94%

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Dong¹,

Tong²,

Wang³

et al. 2023

Transl Lung Cancer Res

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“…We previously investigated NHVTE risk factors and/or anticoagulant use using manual abstraction of REP medical records. [48,49] Our previous studies ascertained NHVTE among Olmsted County residents, using the same VTE case criteria employed in this study, and using CMS-MDS to obtain information on NH admissions for NHVTE cases and age-, sex-, calendar-year-matched NH non-VTE controls. Pharmacologic prophylaxis rates appeared higher for NH residents than for all elderly Olmsted County residents; among NH residents, the proportions receiving pharmacologic prophylaxis 3 months before index were 32% for non-VTE controls and 45% for VTE cases;[48] in our current longitudinal cohort study of NHVTE incidence, a slightly higher 54% of cases received pharmacologic prophylaxis within the 3 months before the incident NHVTE event, perhaps reflecting use of low molecular weight heparin (LMWH) in this later time period (17% of the 111 were treated with LMWH).…”

Section: Discussionmentioning

confidence: 99%

“…Additional NHVTE risk factors were identified in our two previous REP publications, the first employed REP medical record data alone,[48] the second combined REP medical record data with CMS-MDS data. [49] In the first study, NHVTE risk was significantly associated with active malignancy, recent hospitalization, and recent surgery. However, the prevalence of all evaluated VTE risk factors appeared much higher in NH controls than in general population controls, thus the magnitude of risk appeared much lower than for general population estimates (e.g., odds ratio for major surgery = 2.5 [95% CI=1.4–4.3] for NH residents vs 11 [95% CI=7.0–17] for the general population).…”

Section: Discussionmentioning

confidence: 99%

“…In analyses limited to non-hospitalized cases and control subjects, only non-respiratory infection vs no infection was independently associated with VTE. [49] Both previous studies employed case-control designs. Both focused on a single index date, with index defined as NHVTE date for cases and REP encounter date for non-NHVTE NH controls; risk factors were obtained following manual review of detailed medical records over the time frame typically used in REP risk factor studies conducted for the general population (for most characteristics, this is 3 months before index, but for some conditions, the time frame can extend from date first seen by a REP provider until study end).…”

Section: Discussionmentioning

confidence: 99%

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Venous Thromboembolism (VTE) Incidence and VTE-Associated Survival among Olmsted County Residents of Local Nursing Homes

et al. 2018

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Nursing home (NH) residency is an independent risk factor for venous thromboembolism (VTE), but the VTE burden within the NH population is uncertain. This study estimates VTE incidence and VTE-associated mortality among NH residents. We identified all NH residents in any NH in Olmsted County, Minnesota, United States, 1 October 1998 to 31 December 2005 and all first lifetime VTE among county residents to estimate VTE incidence while resident of local NHs (NHVTE), using Centers for Medicare and Medicaid Services Minimum Data Set and Rochester Epidemiology Project resources. We tested associations between NHVTE and age, sex and time since each NH admission using Poisson modelling. Additionally, we tested incident NHVTE as a potential predictor of survival using Cox proportional hazards, adjusting for age, sex and NH residency. Between 1 October 1998 and 31 December 2005, 3,465 Olmsted County residents with ≥1 admission to a local NH, contributed 4,762 NH stays. Of the 3,465 NH residents, 111 experienced incident NHVTE (2.3% of all eligible stays), for an overall rate of 3,653/100,000 NH person-years (NH-PY). VTE incidence was inversely associated with time since each NH admission, and was highest in the first 7 days after each NH admission (18,764/100,000 NH-PY). The adjusted hazard of death for incident NHVTE was 1.90 (95% confidence interval [CI]: 1.38-2.62). In conclusion, VTE incidence among NH residents was nearly 30-fold higher than published incidence rates for the general Olmsted County population. VTE incidence was highest within 7 days after NH admission, and NHVTE was associated with significantly reduced survival. These data can inform future research and construction of clinical trials regarding short-term prophylaxis.

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“…Indeed, current guidelines provide no specific recommendations for thromboprophylaxis in the nursing home setting 3 . This is likely the case because in‐hospital studies cannot be readily used to extrapolate to the nursing home population, due to distinct risk factors for VTE in the nursing home population such as dependency in activities of daily living (ADL), wheelchair use, and frequent/prolonged immobilization 5,8 . Alternatively, there exists an incremental increase of bleeding risk in this vulnerable population based on individual risk factors such as falls, dementia, use of non‐steroidal anti‐inflammatory drugs, and/or renal failure to make a balanced decision on the use of thromboprophylaxis.…”

Section: References Population (Sample Size) Study Type/design Age (Y...mentioning

confidence: 99%

A known unknown? Pharmacological prevention of venous thromboembolism in nursing home residents

Brüggemann

Alnima

Brouns

et al. 2021

J American Geriatrics Society

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Rethinking Guidelines for VTE Risk Among Nursing Home Residents

Cited by 10 publications

References 35 publications

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Risk factors for pulmonary embolism in lung cancer patients with lower limb deep venous thrombosis: a case-control study

Venous Thromboembolism (VTE) Incidence and VTE-Associated Survival among Olmsted County Residents of Local Nursing Homes

A known unknown? Pharmacological prevention of venous thromboembolism in nursing home residents

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