Trends in the Incidence of Deep Vein Thrombosis and Pulmonary Embolism

Silverstein, Marc D.; Heit, John A.; Mohr, David N.; Petterson, Tanya M.; O’Fallon, W. Michael; Melton, L. Joseph

doi:10.1001/archinte.158.6.585

Cited by 2,487 publications

(1,815 citation statements)

References 10 publications

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“…With nearly 10 million annual cases worldwide and an individual lifetime risk of >8%, VTE represents the third leading cause of vascular disease 1, 2, 3. VTE is associated with significant morbidity and mortality, accounting for >200 000 deaths in the United States annually 4.…”

Section: Introductionmentioning

confidence: 99%

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Secemsky

Rosenfield

Kennedy

et al. 2018

JAHA

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BackgroundVenous thromboembolism (VTE) is the third leading cause of vascular disease and accounts for $10 billion in annual US healthcare costs. The nationwide burden of 30‐day readmissions after such events has not been comprehensively assessed.Methods and ResultsWe analyzed adults ≥18 years of age with hospitalizations associated with acute VTE between January 1, 2010, and December 31, 2014, in the Nationwide Readmissions Database. International Classification of Disease, Ninth Revision, Clinical Modification (ICD‐9‐ CM) codes were used to identify hospitalizations associated with acute pulmonary embolism or deep vein thrombosis. The primary outcome was the rate of unplanned 30‐day readmission. Hierarchical logistic regression was used to calculate hospital‐specific 30‐day risk‐standardized readmission rates, a marker of healthcare quality. Among 1 176 335 hospitalizations with acute VTE, in‐hospital death occurred in 6.2%. VTE was associated with malignancy in 19.7%, recent surgery in 19.3%, recent trauma in 4.6%, hypercoagulability in 3.3%, and pregnancy in 1.0%. Among survivors to discharge, the 30‐day readmission rate was 17.5%, with no significant difference in rates across study years (17.4%–17.7%; P=0.10 for trend). Major predictors of readmission were malignancy (relative risk, 1.49, 95% confidence interval 1.47‐1.50), Medicaid insurance (relative risk, 1.48, 95% confidence interval 1.46‐1.50), and nonelective index admission (relative risk, 1.31, 95% confidence interval 1.29‐1.33). Top causes of readmission included sepsis (9.6%) and procedural complications (8.1%). Median rehospitalization costs were $9781.7 (interquartile range, $5430.7–$18 784.1), and 8.1% died during readmission. The interquartile range in risk‐standardized readmission rates was 16.6% to 18.3%, suggesting modest interhospital heterogeneity in readmission risk.ConclusionsNearly 1 in 5 patients with acute VTE were readmitted within 30 days. Predictors and causes of readmission were primarily related to patient characteristics and complications from comorbid conditions, whereas healthcare quality had a moderate impact on readmission risk.

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Section: Introductionmentioning

confidence: 99%

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Secemsky

Rosenfield

Kennedy

et al. 2018

JAHA

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“…In the United States, venous thromboembolism (VTE) is estimated to occur in about 100 persons per 100 000 annually, with about two thirds of cases being DVT 1, 2, 3. The economic and healthcare system burden of VTE is substantial, with estimated annual costs ranging from $13.5 to $27.2 billion (2011 US dollars) 4…”

Section: Introductionmentioning

confidence: 99%

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Margolis

Deitelzweig

Kline

et al. 2016

JAHA

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BackgroundVenous thromboembolism, including deep vein thrombosis and pulmonary embolism, results in a substantial healthcare system burden. This retrospective observational study compared hospital length of stay (LOS) and hospitalization costs for patients with venous thromboembolism treated with rivaroxaban versus those treated with warfarin.Methods and ResultsHospitalizations for adult patients with a primary diagnosis of deep vein thrombosis or pulmonary embolism who were initiated on rivaroxaban or warfarin were selected from MarketScan's Hospital Drug Database between November 1, 2012, and December 31, 2013. Patients treated with warfarin were matched 1:1 to patients treated with rivaroxaban using exact and propensity score matching. Hospital LOS, time from first dose to discharge, and hospitalization costs were reported descriptively and with generalized linear models (GLMs). The final study cohorts each included 1223 patients (751 with pulmonary embolism and 472 with deep vein thrombosis). Cohorts were well matched for demographic and clinical characteristics. Mean (±SD) LOS was 3.7±3.1 days for patients taking rivaroxaban and 5.2±3.7 days for patients taking warfarin, confirmed by GLM‐adjusted results (rivaroxaban 3.7 days, warfarin 5.3 days, P<0.001). Patients with provoked venous thromboembolism admissions showed longer LOSs (rivaroxaban 5.1±4.5 days, warfarin 6.5±5.6 days, P<0.001) than those with unprovoked venous thromboembolism (rivaroxaban 3.3±2.4 days, warfarin 4.8±2.8 days, P<0.001). Days from first dose to discharge were 2.4±1.7 for patients treated with rivaroxaban and 3.9±3.7 for patients treated with warfarin when initiated with parenteral anticoagulants (P<0.001), and 2.7±1.7 and 3.7±2.1, respectively, when initiated without parenteral anticoagulants (P<0.001). Patients initiated on rivaroxaban incurred significantly lower mean total hospitalization costs ($8688±$9927 versus $9823±$9319, P=0.004), confirmed by modeling (rivaroxaban $8387 [95% confidence interval, $8035–$8739]; warfarin $10 275 [95% confidence interval, $9842–$10 708]).ConclusionsRivaroxaban was associated with significantly shorter hospital LOS and lower hospitalization costs compared with warfarin.

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“…Since the first description of an association between VTE and cancer by Trousseau (1868), cancer has emerged as an important risk factor for VTE. A prospective medical database of a county population in the United States reported cancer alone as associated with a 4.1-fold increase in risk of VTE, compared to the annual incidence of a first episode of VTE in the general population of 117 out of 100 000-capita (Silverstein et al, 1998;Heit et al, 2000). Conversely, Sørensen et al (2000) reported that 1-year survival rate was significantly lower in cancer patients with VTE (12%) than in cancer patients without VTE (36%), and the mortality ratio associated with VTE was 2.2 for the 1-year follow-up period.…”

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confidence: 99%

Tissue factor expression as a possible determinant of thromboembolism in ovarian cancer

et al. 2007

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Ovarian cancer, and clear cell carcinoma in particular, reportedly increases the risk of venous thromboembolism (VTE). However, the mechanisms remain unclear. Tissue factor (TF) supposedly represents a major factor in the procoagulant activities of cancer cells. The present study examined the involvement of TF expression in VTE for patients with ovarian cancer. Subjects comprised 32 consecutive patients (mean age 49.8 years) with histologically confirmed ovarian cancer. Presence of VTE was examined using a combination of clinical features, D-dimer levels and venous ultrasonography. Immunohistochemical analysis was used to evaluate TF expression into 4 degrees. Venous thromboembolism was identified in 10 of the 32 patients (31%), including five of the 11 patients with clear cell carcinoma. Tissue factor expression was detected in cancer tissues from 24 patients and displayed significant correlations with VTE development (P ¼ 0.0003), D-dimer concentration (P ¼ 0.003) and clear cell carcinoma (Po0.05). Multivariate analysis identified TF expression as an independent predictive factor of VTE development (Po0.05). Tissue factor (TF) expression is a possible determinant of VTE development in ovarian cancer. In particular, clear cell carcinoma may produce excessive levels of TF and is more likely to develop VTE.

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Trends in the Incidence of Deep Vein Thrombosis and Pulmonary Embolism

Cited by 2,487 publications

References 10 publications

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Tissue factor expression as a possible determinant of thromboembolism in ovarian cancer

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