Cynthia L Leibson1, Tanya M Petterson2, Carin Y Smith2, Kent R Bailey2, Jane A Emerson3, Aneel A Ashrani4, Paul Y Takahashi5, John A Heit6. 1. Division of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: leibson@mayo.edu. 2. Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN. 3. Division of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN. 4. Department of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN. 5. Division of Primary Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN. 6. Department of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Abstract
BACKGROUND: Nursing home (NH) residents are at increased risk for both VTE and bleeding from pharmacologic prophylaxis. Construction of prophylaxis guidelines is hampered by NH-specific limitations with VTE case identification and characterization of risk. We addressed these limitations by merging detailed provider-linked Rochester Epidemiology Project (REP) medical records with Centers for Medicare and Medicaid Services Minimum Data Set (MDS) NH assessments. METHODS: This population-based nested case-control study identified all Olmsted County, Minnesota, residents with first-lifetime VTE October 1, 1998, through December 31, 2005, while a resident of an NH (N = 91) and one to two age-, sex-, and calendar year-matched NH non-VTE control subjects. For each NH case without hospitalization 3 months before VTE (n = 23), we additionally identified three to four nonhospitalized NH control subjects. REP and MDS records were reviewed before index date (VTE date for cases; respective REP encounter date for control subjects) for numerous characteristics previously associated with VTE in non-NH populations. Data were modeled using conditional logistic regression. RESULTS: The multivariate model consisting of all cases and control subjects identified only three characteristics independently associated with VTE: respiratory infection vs no infection (OR, 5.9; 95% CI, 2.6-13.1), extensive or total assistance with walking in room (5.6, 2.5-12.6), and general surgery (3.3, 1.0-10.8). In analyses limited to nonhospitalized cases and control subjects, only nonrespiratory infection vs no infection was independently associated with VTE (8.8, 2.7-29.2). CONCLUSIONS: Contrary to previous assumptions, most VTE risk factors identified in non-NH populations do not apply to the NH population. NH residents with infection, substantial mobility limitations, or recent general surgery should be considered potential candidates for VTE prophylaxis.
BACKGROUND: Nursing home (NH) residents are at increased risk for both VTE and bleeding from pharmacologic prophylaxis. Construction of prophylaxis guidelines is hampered by NH-specific limitations with VTE case identification and characterization of risk. We addressed these limitations by merging detailed provider-linked Rochester Epidemiology Project (REP) medical records with Centers for Medicare and Medicaid Services Minimum Data Set (MDS) NH assessments. METHODS: This population-based nested case-control study identified all Olmsted County, Minnesota, residents with first-lifetime VTE October 1, 1998, through December 31, 2005, while a resident of an NH (N = 91) and one to two age-, sex-, and calendar year-matched NH non-VTE control subjects. For each NH case without hospitalization 3 months before VTE (n = 23), we additionally identified three to four nonhospitalized NH control subjects. REP and MDS records were reviewed before index date (VTE date for cases; respective REP encounter date for control subjects) for numerous characteristics previously associated with VTE in non-NH populations. Data were modeled using conditional logistic regression. RESULTS: The multivariate model consisting of all cases and control subjects identified only three characteristics independently associated with VTE: respiratory infection vs no infection (OR, 5.9; 95% CI, 2.6-13.1), extensive or total assistance with walking in room (5.6, 2.5-12.6), and general surgery (3.3, 1.0-10.8). In analyses limited to nonhospitalized cases and control subjects, only nonrespiratory infection vs no infection was independently associated with VTE (8.8, 2.7-29.2). CONCLUSIONS: Contrary to previous assumptions, most VTE risk factors identified in non-NH populations do not apply to the NH population. NH residents with infection, substantial mobility limitations, or recent general surgery should be considered potential candidates for VTE prophylaxis.
Authors: John A Heit; W Michael O'Fallon; Tanya M Petterson; Christine M Lohse; Marc D Silverstein; David N Mohr; L Joseph Melton Journal: Arch Intern Med Date: 2002-06-10
Authors: Jennifer L St Sauver; Brandon R Grossardt; Barbara P Yawn; L Joseph Melton; Walter A Rocca Journal: Am J Epidemiol Date: 2011-03-23 Impact factor: 4.897
Authors: Cynthia L Leibson; Anna N A Tosteson; Sherine E Gabriel; Jeanine E Ransom; L Joseph Melton Journal: J Am Geriatr Soc Date: 2002-10 Impact factor: 5.562
Authors: Tanya M Petterson; Carin Y Smith; Jane A Emerson; Kent R Bailey; Aneel A Ashrani; John A Heit; Cynthia L Leibson Journal: Thromb Haemost Date: 2018-07-02 Impact factor: 5.249
Authors: Renée A G Brüggemann; Teba Alnima; Steffie H A Brouns; Nordin M J Hanssen; Jos M G A Schols; Hugo Ten Cate; Bart Spaetgens; Arina J Ten Cate-Hoek Journal: J Am Geriatr Soc Date: 2021-08-23 Impact factor: 7.538