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Declining Long-term Risk of Adverse Events after First-time Community-presenting Venous Thromboembolism: The
W Huang1, R J Goldberg2, A T Cohen3
1Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Thrombosis Research
|April 30, 2015
Summary
Management of venous thromboembolism (VTE) shifted to the community, improving outcomes like mortality and recurrent VTE. However, high adverse event rates necessitate new risk assessment tools for long-term VTE patient care.
Area of Science:
- Clinical Epidemiology
- Public Health
- Cardiovascular Medicine
Background:
- Healthcare delivery trends are shifting venous thromboembolism (VTE) management from hospitals to the community.
- This shift impacts VTE prevention, treatment, and patient outcomes.
- Understanding these changes is crucial for optimizing VTE care.
Purpose of the Study:
- To analyze trends in the community-based management of VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]).
- To evaluate the impact of these management shifts on patient outcomes over a decade.
- To identify needs for improved long-term VTE risk assessment.
Main Methods:
- Population-based surveillance study of VTE patients in the Worcester, Massachusetts metropolitan statistical area (WMSA) from 1999-2009.
- Inclusion of 2334 residents diagnosed with first-time community-presenting VTE.
- Follow-up of patients for up to 3 years post-diagnosis.
Main Results:
- Hospitalization rates for DVT-alone decreased significantly (67% to 37%), while PE patients remained hospitalized.
- Mean length of hospital stay for VTE patients decreased.
- Treatment evolved towards newer anticoagulants, with significant reductions in 3-year cumulative rates of all-cause mortality (41% to 26%), major bleeding (12% to 6%), and recurrent VTE (17% to 9%).
Conclusions:
- A decade of VTE management changes was associated with improved long-term patient outcomes.
- Despite improvements, adverse event rates remain substantial.
- Development of novel risk-assessment tools is essential to identify high-risk individuals for better long-term management of VTE complications.
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