Predictors of post discharge venous thromboembolism [abstract]
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Spencer et al (Arch Intern Med 2007) found that most venous thromboembolic (VTE) events were diagnosed in the 3 months following hospitalization. In this study, we sought to evaluate the predictors of post-discharge VTE. We retrospectively reviewed discharge instructions of consecutively admitted adult patients with hospital length of stay 2 days or longer. A VTE risk score previously validated by Kucher and colleagues was used to classify risk groups (NEJM 2005). Patients were considered high risk if VTE risk score was 4 or greater. Outcomes were development of VTE, readmission, and mortality 90-120 days post discharge. 489 patients were included in this analysis. Only 17 (3.5%) charts included VTE specific discharge orders. High-risk patients constituted 18.4% of the cohort. Only 12 (3%) of the low risk group received specific VTE discharge instruction versus 5 (5.6%) of the high-risk patients. This finding was not statistically significant. Of the low risk patients, 0.8% developed VTE compared to 4.4% of high-risk patients (p=0.008). All cause mortality was higher in the high-risk group [11(2.8) vs. 7(7.8); 0.022]. Prior VTE and cancer were independent risk factors for the development of VTE (p values 0.002 and 0.02 respectively). In our cohort, only 5.6% of high-risk patients for VTE received specific VTE discharge instructions. It may be necessary to evaluate patients at discharge with this risk score to discern and predict the development of VTE. Our findings demand for more emphasis on VTE education for high-risk patients on discharge.