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Venous thromboembolism prophylaxis and clinical consequences in medically ill patients.
[acute rheumatic fever]
The
objective
of
this
study
was
to
examine
venous
thromboembolism
(
VTE
)
prophylaxis
use
,
risk
reduction
,
and
readmission
in
medically
ill
patients
during
hospitalization
and
after
discharge
.
This
5
-
year
retrospective
study
linked
outpatient
files
from
MarketScan
Commercial
and
Medicare
Supplemental
databases
.
Patients
were
categorized
into
prophylaxis
and
non-prophylaxis
groups
based
on
guideline-recommended
anticoagulant
use
from
the
index
date
to
180
days
posthospital
discharge
and
before
the
first
VTE
event
date
.
Outcome
variables
were
VTE
events
and
rehospitalization
.
Risk
adjustment
was
conducted
within
the
prophylaxis
group
and
between
the
prophylaxis
and
non-prophylaxis
groups
using
propensity
score
matching
.
Among
4467
patients
,
28
.
99
%
of
the
patients
(
n
=
1295
)
were
admitted
with
cancer
,
18
.
03
%
(
n
=
805
)
with
pneumonia
,
14
.
06
%
(
n
=
628
)
with
heart
failure
,
11
.
06
%
(
n
=
494
)
with
stroke
,
11
.
11
%
(
n
=
496
)
with
sepsis
,
8
.
08
%
(
n
=
361
)
with
infectious
diseases
,
5
.
6
%
(
n
=
250
)
with
severe
respiratory
disorders
,
1
.
81
%
(
n
=
81
)
with
inflammatory
bowel
disease
,
1
.
05
%
(
n
=
47
)
with
obesity
,
0
.
20
%
(
n
=
9
)
with
neurologic
disorders
,
and
0
.
02
%
(
n
=
1
)
with
acute
rheumatic
fever
.
Among
those
with
180
-
day
continuous
enrollment
after
the
index
date
(
n
=
3511
)
,
51
.
81
%
(
n
=
1819
)
received
anticoagulant
therapy
only
,
2
.
48
%
(
n
=
87
)
received
mechanical
compression
treatment
only
(
stocking
or
pneumatic
compression
)
,
and
4
.
41
%
(
n
=
155
)
received
both
during
hospitalization
.
Anticoagulant
therapy
rates
ranged
from
88
.
64
%
(
obesity
)
to
32
.
39
%
(
inflammatory
bowel
disease
)
.
Among
anticoagulant
therapy
patients
,
740
patients
(
40
.
68
%
)
received
low
-molecular
weight
heparin
only
and
806
patients
(
44
.
31
%
)
received
unfractionated
heparin
.
After
risk
adjustment
,
compared
with
patients
without
VTE
prophylaxis
,
anticoagulant
prophylaxis
patients
had
lower
VTE
(
3
.
62
%
vs
.
4
.
27
%
,
P
<
0
.
04
)
and
readmission
rates
(
24
.
22
%
vs
.
27
.
95
%
,
P
<
0
.
02
)
during
the
6
months
post-index
hospital
admission
.
In
conclusion
anticoagulant
prophylaxis
is
underutilized
and
is
associated
with
reduced
VTE
risk
and
a
decrease
in
rehospitalizations
for
medically
ill
patients
.
Diseases
Validation
Diseases presenting
"thromboembolism"
symptom
acute rheumatic fever
heparin-induced thrombocytopenia
homocystinuria without methylmalonic aciduria
oral submucous fibrosis
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
waldenström macroglobulinemia
This symptom has already been validated