J Stroke.  2023 Jan;25(1):151-159. 10.5853/jos.2022.02215.

Trends in Venous Thromboembolism Readmission Rates after Ischemic Stroke and Intracerebral Hemorrhage

• Shu L
• Havenon Ad
• Liberman AL
• Henninger N
• Goldstein E
• Reznik ME
• Mahta A
• Al-Mufti F
• Frontera J
• Furie K
• Yaghi S

• KMID: 2539068
• DOI: http://doi.org/10.5853/jos.2022.02215

Abstract

Background and Purpose
Venous thromboembolism (VTE) is a life-threatening complication of stroke. We evaluated nationwide rates and risk factors for hospital readmissions with VTE after an intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS) hospitalization.
Methods
Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included patients with a principal discharge diagnosis of ICH or AIS from 2016 to 2019. Patients who had VTE diagnosis or history of VTE during the index admission were excluded. We performed Cox regression models to determine factors associated with VTE readmission, compared rates between AIS and ICH and developed post-stroke VTE risk score. We estimated VTE readmission rates per day over a 90-day time window post-discharge using linear splines.
Results
Of the total 1,459,865 patients with stroke, readmission with VTE as the principal diagnosis within 90 days occurred in 0.26% (3,407/1,330,584) AIS and 0.65% (843/129,281) ICH patients. The rate of VTE readmission decreased within first 4–6 weeks (P<0.001). In AIS, cancer, obesity, higher National Institutes of Health Stroke Scale (NIHSS) score, longer hospital stay, home or rehabilitation disposition, and absence of atrial fibrillation were associated with VTE readmission. In ICH, longer hospital stay and rehabilitation disposition were associated with VTE readmission. The VTE rate was higher in ICH compared to AIS (adjusted hazard ratio 2.86, 95% confidence interval 1.93–4.25, P<0.001).
Conclusions
After stroke, VTE readmission risk is highest within the first 4–6 weeks and nearly three-fold higher after ICH vs. AIS. VTE risk is linked to decreased mobility and hypercoagulability. Studies are needed to test short-term VTE prophylaxis beyond hospitalization in high-risk patients.

Keyword

Acute stroke; Deep venous thrombosis; Venous thromboembolism; Pulmonary embolism

Figure

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  Figure 1. Flow chart of the study. AIS, acute ischemic stroke; ICH, intracerebral hemorrhage; VTE, venous thromboembolism. *Patients may have more than one exclusion reason.

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  Figure 2. Trends in venous thromboembolism readmissions in (A) acute ischemic stroke (AIS) and (B) intracerebral hemorrhage (ICH) over 90 days.

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  Figure 3. Kaplan-Meier survival estimates of venous thromboembolism readmission in acute ischemic stroke (AIS) vs. intracerebral hemorrhage (ICH).

Reference

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