Abstract
Background
Patients with venous thromboembolism (VTE) treated with anticoagulants are at risk
of death from pulmonary embolism (PE) and/or bleeding. However, whether patients who
develop VTE in hospital have a higher complication rate than those who develop VTE
in an outpatient setting is unclear.
Patients and methods
RIETE is an ongoing, prospective registry of consecutive patients with acute, objectively
confirmed, symptomatic VTE. We compared the 3-month incidence of fatal PE and fatal
bleeding in patients in whom the VTE had developed while in hospital for another medical
condition (inpatients) with those who presented to the emergency ward because of VTE
(outpatients).
Results
Up to April 2008, 22,133 patients with acute VTE were enrolled: 10,461 (47%) presented
with PE, 11,672 with deep vein thrombosis. Overall, 6445 (29%) were inpatients. During
the study period, those who developed VTE as inpatients had a significantly higher
incidence of fatal PE (2.1% vs. 1.5%; odds ratio: 1.4; 95% CI: 1.1–1.7), overall death
(7.0% vs. 5.4%; odds ratio: 1.3; 95% CI: 1.2–1.5), and major bleeding (2.9% vs. 2.1%;
odds ratio: 1.4; 95% CI: 1.1–1.6) than outpatients. The incidence of fatal bleeding
was not significantly increased (0.7% vs. 0.5%; odds ratio: 1.2; 95% CI: 0.9–1.8).
In multivariable analysis, inpatient status was significantly associated with a higher
risk for fatal PE (odds ratio: 1.3; 95% CI: 1.1–1.7).
Conclusions
VTE occurring in hospitalized patients carries a significantly higher risk for death
of PE than in outpatients, underscoring the importance of VTE prevention strategies
in the hospital setting.
Keywords
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Article info
Publication history
Published online: August 02, 2010
Accepted:
July 6,
2010
Received in revised form:
July 2,
2010
Received:
June 9,
2010
Identification
Copyright
© 2010 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
