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Some Patients With IBD Need Thromboprophylaxis After Hospitalization
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Researchers from The Ottawa Hospital in Canada developed a risk score that may help identify which patients with inflammatory bowel disease need extended protection against venous thromboembolism after hospitalization.
Jeffrey D. McCurdy, MD, PhD, FRCPC, of the division of gastroenterology and hepatology at the hospital, and colleagues wrote in Alimentary Pharmacology & Therapeutics that prophylaxis is a regular practice for when risk is highest, when patients are in the hospital. However, just because they are out of the hospital does not mean that risk goes away.
“The vast majority of patients do not receive pharmacologic prophylaxis after discharge,” they wrote. “Therefore, the post-discharge setting likely remains a vulnerable period for patients with IBD.”
To determine incidence and risk factors associated with VTE in patients with IBD and create a point-of-care predictive model, researcher analyzed data from the hospital’s institutional discharge database. They assessed patients discharged between 2009 and 2016 for VTE through chart review and identified risk factors for VTE within 3 months of discharge.
Of 2,161 eligible discharges, 66 were associated with VTE within 6 months of hospitalization with a median time to event of 37 days (range, 3-182 days).
In their analysis, researchers found that being older than 45 years (OR = 3.76; 95% CI, 1.8-7.89) and multiple admission (OR = 2.62; 95% CI, 1.34-5.11) were independently associated with risk for VTE.
McCurdy and colleagues incorporated being older than 45 years, multiple admissions, ICU admission, length of admission more than 7 days and central catheter into their final predictive model. Their score was able to discriminate between discharges associated with and without VTE (optimism-corrected C-statistic, 0.7; 95% CI, 0.58-0.77).
By separating patients into high-, medium- and low-risk groups and focusing treatment to the high-risk group, researchers found that extended thromboprophylaxis can be avoided in 92% of discharges with a miss rate of 1.6%.
“The use of a patient-specific risk score provides a more rational basis for determining when extended thromboprophylaxis should be considered,” McCurdy and colleagues wrote. “Prior to the universal adoption of our model into routine clinical practice, external validation in an independent cohort and a comprehensive cost-effective study is required.” – by Alex Young
Disclosures: McCurdy reports he receives honoraria from AbbVie, Janssen and Takeda. Please see the study for all other authors’ relevant financial disclosures.
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