Triggers of hospitalization for venous thromboembolism.

TitleTriggers of hospitalization for venous thromboembolism.
Publication TypeJournal Article
Year of Publication2012
AuthorsRogers, MAM, Levine, DA, Blumberg, N, Flanders, SA, Chopra, V, Langa, KM
Date Published2012 May 01
ISSN Number1524-4539
KeywordsAged, Ambulatory Care Facilities, Comorbidity, Cross-Over Studies, Emergency Service, Hospital, Female, Hematinics, Home Care Services, Hospitalization, Humans, Immobilization, Incidence, Infections, Male, Medicare, Middle Aged, Office Visits, Postoperative Complications, Pulmonary Embolism, Risk Factors, Skilled Nursing Facilities, Transfusion Reaction, United States, Venous Thrombosis

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.


Rogers, Mary A M Levine, Deborah A Blumberg, Neil Flanders, Scott A Chopra, Vineet Langa, Kenneth M 5R21HL093129-02/HL/NHLBI NIH HHS/ R01 HL095467/HL/NHLBI NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Circulation. 2012 May 1;125(17):2092-9. Epub 2012 Apr 3.

User Guide Notes

Endnote Keywords

medicare claims/HOSPITALIZATION/venous thromboembolism/pulmonary embolism

Endnote ID


Alternate JournalCirculation
Citation Key7711
PubMed ID22474264
PubMed Central IDPMC3342773
Grant ListU01 AG009740 / AG / NIA NIH HHS / United States
R21 HL093129-02 / HL / NHLBI NIH HHS / United States
R21 HL093129 / HL / NHLBI NIH HHS / United States
R01 HL095467 / HL / NHLBI NIH HHS / United States
5R21HL093129-02 / HL / NHLBI NIH HHS / United States
U01AG009740 / AG / NIA NIH HHS / United States
R21 HL093129-01A1 / HL / NHLBI NIH HHS / United States