Characteristics of Consecutively Diagnosed Inpatient VTE at a Tertiary Care Center: Unexpectedly High Prevalence and Mortality of Upper Extremity DVT
Thomas Maldonado, MD, Neel Ranganath, Patricia Yau, MD, Mikel Sadek, MD, Jeffrey Berger, MD, Caron Rockman, MD.
New York University Medical Center, New York, NY, USA.
OBJECTIVES: Venous thromboembolic disease (VTE) is a condition with significant morbidity and potential mortality; its occurrence in hospitalized patients is felt to be a marker of compromised quality of care. The goal of the current study was to analyze a cohort of consecutively diagnosed inpatient cases of VTE at our tertiary care center.
METHODS: A retrospective review was performed of prospective data on all consecutive patients diagnosed with acute VTE at a tertiary care center during a six-month period (7-12/2015). Provoked VTE was defined as any patient with surgery, immobilization, trauma, infection, central venous access, pregnancy, or hormonal medication use within 30 days of diagnosis.
RESULTS: VTE diagnosis was made in 97 inpatients (49.5% females, mean age 67.8 years). Patient characteristics included:
13.4% prior VTE, 42.3% smoking history, 49.5% malignancy, 50.5% recent major surgery. Of patients with recent surgery, orthopedic was the most common type (14.4%). Nevertheless, 14.4% of VTE cases diagnosed in the inpatient setting were classified as "unprovoked". Extremity DVT was diagnosed in 74.2% of cases, PE in 14.4% of cases, and simultaneous DVT and PE in 11.3% of cases. Incidentally diagnosed asymptomatic VTE occurred in 17.5% of cases. Of 83 patients diagnosed with extremity DVT, 35 (42.2%) were in the upper extremity. Of these, 66.7% were associated with central venous access. Of 48 patients diagnosed with lower extremity DVT, 14 (29.2%) were in proximal veins, 23 (47.9%) were in distal veins, and 11 (22.9%) were in both distributions. IVC filters were placed in 26.9% of cases, with the most common indication being a contraindication to anticoagulation (64%). Of patients diagnosed with inpatient VTE, 8.2% expired on the same admission. Patients with upper extremity DVT were significantly more likely to expire on the same admission than patients with other types of VTE (17.1% vs 4%, p=0. 04).
CONCLUSIONS: The development of inpatient VTE is felt by regulatory bodies to represent a marker of poor quality of care, with a presumption that VTE is preventable. Our results suggest that upper extremity DVT represents a significant proportion of hospital acquired DVT, and that these cases are representative of the underlying comorbidities in these patients and their need for invasive venous access rather than a "failure" of VTE thromboprophylaxis and a marker for poor quality.
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