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Major bleeding after hospitalization for deep-venous thrombosis.

R H White1, R J Beyth, H Zhou

  • 1Division of General Medicine, University of California, Davis, USA.

The American Journal of Medicine
|November 24, 1999
PubMed
Summary

Patients with deep-vein thrombosis (DVT) face a higher risk of major bleeding after hospital discharge, particularly within the first 30 days. Risk factors include prior bleeding, alcohol use, and chronic conditions.

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Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Public Health

Background:

  • Oral anticoagulant therapy is crucial for managing deep-vein thrombosis (DVT).
  • Bleeding is a significant adverse event associated with oral anticoagulants.
  • Previous studies often lacked control groups for assessing bleeding risk.

Purpose of the Study:

  • To determine the incidence, time course, and risk factors for major bleeding post-discharge in DVT patients.
  • To estimate the excess bleeding risk attributable to oral anticoagulant therapy.
  • To compare bleeding rates in DVT patients with control groups.

Main Methods:

  • Analysis of 22,000 adult DVT patients hospitalized in California (1992-1994).
  • Identification of risk factors for readmission due to bleeding.

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  • Comparison with matched cohorts of patients with pneumonia or cellulitis.

    • Main Results:

    • 1.4% of DVT patients were readmitted for bleeding within 91 days, with rates highest in the first 30 days.
    • Risk factors included prior gastrointestinal bleeding, alcohol-related diagnoses, chronic renal disease, female gender, malignancy, nonwhite race, and age >65.
    • DVT patients had a 2-fold higher risk of readmission for bleeding compared to cellulitis or pneumonia cohorts.

    Conclusions:

    • Rehospitalization for bleeding is a significant concern following DVT treatment, peaking in the initial post-discharge period.
    • The risk of bleeding is approximately double that of patients hospitalized for other conditions like cellulitis or pneumonia.
    • Further research is needed to understand the increased risk observed in women and nonwhite patients.