OC 61.1 - Risk factors for bleeding after recent medical hospitalization: The Medical Inpatient Thrombosis and Hemostasis Study (MITH)

Tuesday, July 12, 2022

2:45 PM – 3:00 PM

Location: ExCel Center, S11A

Presentation Format: Virtual

Presenting Author(s)

Mansour Gergi, MD

Assistant Professor
Hematology/Oncology Division, Department of Medicine, The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States

Co-Author(s)

KW

Katherin Wilkinson

Biostatistician
Larner College of medicine at the University of vermont
Burlington, Vermont, United States
Andrew D. Sparks, MS

Statistician
The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States
Hanny Al-Samkari, MD

Assistant Professor of Medicine
Harvard Medical School
Boston, Massachusetts, United States
NS

Nicholas L. Smith

Professor, Epidemiology
Department of Epidemiology, School of Public Health, University of Washington
Seattle, Washington, United States
NR

Nicholas S. Roetker

Epidemiologist
Hennepin Healthcare Research Institute
Minneapolis, Minnesota, United States
TP

Timothy B. Plante

Hospitalist
University of Vermont Medical Center
Burlington, Vermont, United States
Mary Cushman, MD, MSc

Professor
Department of Medicine, Larner College of Medicine at the University of Vermont, USA
Colchester, Vermont, United States
AR

Allen Repp

Internal Medicine Hospitalist, Professor
University of Vermont
Burlington, Vermont, United States
CH

Chris Holmes

Professor, Hematologist
University of Vermont College of Medicine
Burlington, Vermont, United States
Neil A. Zakai, MD, MSc

Professor
Hematology/Oncology Division, Department of Medicine, The Larner College of Medicine at the University of Vermont
Burlington, Vermont, United States

Background: Assessing bleeding risk in recently discharged medical patients is essential in decisions regarding venous thrombosis prophylaxis. Studies assessing post-discharge bleeding risk in this population of patients are lacking. To appropriately risk stratify people for post-discharge venous thrombosis prophylaxis, bleeding risk needs to be better understood.

Aims: To quantify the risk of and risk factors for bleeding after medical hospital discharge.

Methods: We followed all primary care patients aged ≥18 years at the University of Vermont Medical Center’s primary care clinics from July 2010 to September 2019. We applied validated computable phenotypes to electronic health record data and identified post-discharge (PD) bleeding events that required re-hospitalization within 90 days of the index hospital discharge. We report age and sex-adjusted odds ratios (OR) for putative bleeding risk factors.

Results: Between 2010-2019, there were a total of 14,266 medical hospitalizations and 1216 PD-bleeding events requiring re-admission. The bleeding rate for patients who did not have any medical hospitalizations in the past 90 days was 2.9 per 1000-person years compared to 98.9 per 1000 person-years for PD-bleeding up to 90 days after discharge. History of cancer, liver disease, renal failure, heart disease and bleeding disorder were associated with increased risk of PD-bleeding. Patients with anemia and thrombocytopenia or elevated creatinine at the time of discharge were also at increased risk for bleeding. The highest OR (6.2) was observed in patients who presented with bleeding at the time of the index admission (Table 1).

Conclusion(s): Bleeding requiring re-hospitalization is common after discharge from medical hospitalizations. There are easily identifiable, common, and strong risk factors for post-discharge bleeding. Development of risk assessment models for post-discharge bleeding may help guide patient care and is the focus of ongoing research.