Journal Article Ppublish 4 citations
PubMed: 40122464 DOI: 10.1016/j.jtha.2025.02.044
Anticoagulation and other risk factors for clinically relevant bleeding after medical hospitalization: the Medical Inpatient Thrombosis and Hemostasis Study.
J Thromb Haemost 23(7):2122-2132
Authors: Mansour Gergi, Katherine Wilkinson, Andrew Sparks, Nicholas S Roetker, Hanny Al-Samkari, Nicholas L Smith, Timothy B Plante, Mary Cushman, Allen B Repp, Chris E Holmes, Karlyn Martin, Neil A Zakai
Affiliations
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA; Division of Hematology/Oncology, University of Vermont Medical Center, Burlington, Vermont, USA.
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA; Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.
- Division of Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
- Department of Epidemiology, University of Washington, Seattle, Washington, USA; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA; Division of Hematology/Oncology, University of Vermont Medical Center, Burlington, Vermont, USA.
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA; Division of Hematology/Oncology, University of Vermont Medical Center, Burlington, Vermont, USA; Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA.
Abstract
BACKGROUND
Clinically relevant bleeding after discharge from a medical hospitalization is associated with increased morbidity and mortality. There is limited knowledge of the risk factors for this bleeding.
OBJECTIVES
We aimed to determine the risk factors for bleeding leading to rehospitalization after hospital discharge.
METHODS
The study population consisted of primary care patients followed longitudinally from October 2010 to September 2019 for medical hospitalization and clinically relevant bleeding. People discharged alive from a medical hospitalization were followed for up to 90 days for postdischarge bleeding requiring rehospitalization. Age-, sex- (male vs female), and length of stay-adjusted hazard ratios for candidate bleeding risk factors were estimated using Cox proportional hazards models.
RESULTS
Over 9 years, there were 15 630 medical hospitalization discharges and 414 (2.6%) postdischarge clinically relevant bleeding events that required readmission. Clinical and patient factors related to the postdischarge bleeding risk were increasing age, active cancer, liver disease, creatinine concentration of >2 g/dL, heart disease, and history of previous gastrointestinal or central nervous system bleeding. Hemoglobin concentrations of <12 g/dL for women and <13.6 g/dL for men, a platelet count of <50 × 10 3 mm 3, and anticoagulation at discharge were also associated with an increased risk for clinically relevant bleeding postdischarge.
CONCLUSION
Postdischarge bleeding requiring hospitalization occurs in 2.6% of medical hospitalizations and has objective and readily identifiable risk factors. Findings suggest that clinically relevant bleeding postdischarge may be predictable and quantifiable, which could help increase the safety of anticoagulation decisions at discharge.
MeSH
Hemorrhage, Hospitalization, Electronic Health Records, Risk Factors, Thrombosis, Hemostasis