Temporal Changes in Hospital-Captured 90-Day Care After Venous Thromboembolism: A 16-Year Electronic Health Record...

Direct oral anticoagulants (DOACs) have simplified treatment for venous thromboembolism (VTE), but fewer mandatory monitoring visits may reduce opportunities for structured reassessment. We evaluated temporal changes in hospital-captured documentation of post-VTE care processes during the transition to DOAC-based treatment, including initial anticoagulation, clinical follow-up, laboratory monitoring, and selective imaging reassessment.

We conducted a single-center retrospective electronic health record cohort study using routinely collected vascular surgery outpatient and inpatient records from Peking University People's Hospital between 2009 and 2024. Patients with VTE-related evidence and a definable hospital-captured index date were included. Treatment eras were prespecified as 2009-2014, 2015-2019, and 2020-2024. The study-defined documentation measure comprised therapeutic anticoagulation within 14 days and clinical follow-up, laboratory monitoring, and selective VTE-related ultrasound or imaging reassessment within 15-90 days.

Among 5998 patients with a definable hospital-captured index VTE-related event, the median age was 64.0 years, and 55.3% were female. Documented anticoagulation within 14 days increased from 34.1% in 2009-2014 to 58.0% in 2020-2024. Within 15-90 days, clinical follow-up was documented in 1483 patients (24.7%), laboratory monitoring in 366 (6.1%), and VTE-related ultrasound or imaging reassessment in 578 (9.6%). All four prespecified domains were documented in 149 patients (2.5%) overall and in 3.2% during 2020-2024. In multivariable analysis, the 2020-2024 era, pulmonary embolism presentation, and upper-extremity or catheter-related VTE were associated with higher odds of four-domain documentation completion.

In this 16-year electronic health record cohort, hospital-captured documentation of early anticoagulation increased, whereas documentation of 90-day follow-up processes remained infrequent; incomplete documentation or care delivered outside the hospital system may have contributed. These findings highlight opportunities to strengthen continuity and traceability of post-VTE management through timely clinical review and individualized decisions regarding treatment duration, safety monitoring, and selective imaging when clinically indicated.