Venous Thromboembolism after Hospital Discharge: Temporal Trends in Baseline Characteristics, Prevention, Treatment, and 90-day Outcomes

Benjamin Brenner; Inna Tzoran; Behnood Bikdeli; Reina Valle; Géraldine Poenou; Raimundo Tirado-Miranda; María L. Pesce; Javier Pagán-Escribano; Matteo Giorgi-Pierfranceschi; Manuel Monreal; the RIETE Investigators

doi:10.1055/s-0044-1791817

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2025; 51(03): 301-311
DOI: 10.1055/s-0044-1791817

Review Article

Venous Thromboembolism after Hospital Discharge: Temporal Trends in Baseline Characteristics, Prevention, Treatment, and 90-day Outcomes

Authors

Benjamin Brenner

¹Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

²The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
Inna Tzoran

¹Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

²The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
Behnood Bikdeli

³Cardiovascular Medicine Division and the Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

⁴Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut

⁵Cardiovascular Research Foundation, New York, New York
Reina Valle

⁶Department of Internal Medicine, Hospital Sierrallana, Santander, Spain
Géraldine Poenou

⁷Department of Médecine et Thérapeutique, Hôpital Nord—CHU St-Etienne, Saint-Etienne, France
Raimundo Tirado-Miranda

⁸Department of Internal Medicine, Hospital Infanta Margarita, Córdoba, Spain
María L. Pesce

⁹Department of Internal Medicine, Hospital General Universitario de Elda, Alicante, Spain
Javier Pagán-Escribano

¹⁰Department of Internal Medicine, Hospital General Universitario Morales Meseguer, Murcia, Spain
Matteo Giorgi-Pierfranceschi

¹¹Department of Internal Medicine, Istituti Ospitalieri di Cremona, Cremona, Italy
Manuel Monreal

¹²Department of Internal Medicine, CIBER de Enfermedades Respiratorias, Madrid, Spain

¹³Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM—Universidad Católica San Antonio de Murcia, Spain

the RIETE Investigators

Abstract

Venous thromboembolism (VTE) after hospital discharge poses a serious health risk. Assessments of patient characteristics, prophylaxis, treatment, outcomes, and over time changes lack consistency. Data on 16,901 hospitalized patients in the Registro Informatizado Enfermedad TromboEmbolica registry (2003–2022) were analyzed to evaluate trends in baseline characteristics, prophylaxis, treatments, and 90-day outcomes among medical (6,218) and surgical (10,683) patient cohorts. Multivariable logistic regression was used to assess the risks of the composite of fatal pulmonary embolism (PE) or recurrent VTE and major bleeding. The proportion of patients who presented with PE increased among medical (from 54 to 72%) and surgical patients (from 55 to 58%). Prophylaxis use increased in medical patients (from 53 to 71%), while decreasing in surgical patients (from 67 to 58%). Notably, the 90-day composite of fatal PE or recurrent VTE decreased in medical (from 3.9 to 1.8%) and surgical patients (from 2.9 to 1.2%; p < 0.001 for both). Conversely, major bleeding increased (3.1 to 4.5%) in medical patients (p = 0.008), with no change in surgical patients (from 2.5 to 2.4%). Risk-adjusted analysis showed a yearly decrease in the risk for the composite outcome (subhazard ratio [sHR]: 0.95; 95% confidence interval [CI]: 0.93–0.98) in medical and surgical patients and an increase in the risk for major bleeding in medical patients only (sHR: 1.04; 95% CI: 1.01–1.07). Results were consistent after excluding coronavirus disease 2019 patients. Over 20 years, the composite of fatal PE or recurrent VTE within 90 days had significantly decreased in VTE patients after hospitalization for medical or surgical care. Medical patients, however, exhibited an increase in major bleeding.

Keywords

hospital-acquired VTE - medical patients - surgical patients - anticoagulation - bleeding

Full Text

References

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