TY - JOUR
T1 - All-cause mortality and use of antithrombotics within 90 days of discharge in acutely ill medical patients
AU - Mahan, Charles E.
AU - Fields, Larry E.
AU - Mills, Roger M.
AU - Stephenson, Judith J.
AU - Fu, An Chen
AU - Fisher, Maxine D.
AU - Spyropoulos, Alex C.
N1 - Publisher Copyright:
© Schattauer 2015.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Conflicting evidence exists regarding predictors of and antithrombotic benefit on mortality in hospitalised acutely-ill medical patients. We compared mortality risk within 90 days post-discharge among medically ill patients who did and did not receive antithrombotics. This retrospective claims analysis included patients ≥ 40 years with nonsurgical hospitalisation ≥ 2 days between 2005 and 2009 using the HealthCore Integrated Research Database. Antithrombotic use (i.e. anticoagulants and antiplatelets) post-discharge was captured from pharmacy claims. All-cause mortality was determined from Social Security Death Index; cause of death was identified from National Death Index database. Kaplan-Meier survival curves were generated and hazard ratios (HR) for mortality risk were estimated using Cox proportional hazards models. Patients prescribed anticoagulants or antiplatelets post-discharge had lower risk of short-term mortality. For the anticoagulant model, the most significant predictors of mortality were malignant/benign neoplasms (hazard ratio [HR] 1.6, 95 % confidence interval [CI] 1.5-1.7), liver disease (HR 1.6, 95 % CI 1.5-1.7), anticoagulant omission (HR 1.6, 95 % CI 1.4-1.8), gastrointestinal or respiratory tract intubations (HR 1.5, 95 % CI 1.3-1.7), and blood dyscrasias (HR 1.4, 95 % CI 1.4-1.5). For the antiplatelet model, the most significant predictors of mortality were antiplatelet omission (HR 3.7, 95 % CI 3.3-4.1), liver disease (HR 1.6, 95 % CI 1.4-1.7), malignant/benign neoplasms (HR 1.6, 95 % CI 1.5-1.6), gastrointestinal or respiratory tract intubations (HR 1.5, 95 % CI 1.3-1.7), and blood dyscrasias (HR 1.4, 95 % CI 1.4-1.5). These mortality risk factors may guide future studies assessing potential benefits of antithrombotics in specific subsets of patients.
AB - Conflicting evidence exists regarding predictors of and antithrombotic benefit on mortality in hospitalised acutely-ill medical patients. We compared mortality risk within 90 days post-discharge among medically ill patients who did and did not receive antithrombotics. This retrospective claims analysis included patients ≥ 40 years with nonsurgical hospitalisation ≥ 2 days between 2005 and 2009 using the HealthCore Integrated Research Database. Antithrombotic use (i.e. anticoagulants and antiplatelets) post-discharge was captured from pharmacy claims. All-cause mortality was determined from Social Security Death Index; cause of death was identified from National Death Index database. Kaplan-Meier survival curves were generated and hazard ratios (HR) for mortality risk were estimated using Cox proportional hazards models. Patients prescribed anticoagulants or antiplatelets post-discharge had lower risk of short-term mortality. For the anticoagulant model, the most significant predictors of mortality were malignant/benign neoplasms (hazard ratio [HR] 1.6, 95 % confidence interval [CI] 1.5-1.7), liver disease (HR 1.6, 95 % CI 1.5-1.7), anticoagulant omission (HR 1.6, 95 % CI 1.4-1.8), gastrointestinal or respiratory tract intubations (HR 1.5, 95 % CI 1.3-1.7), and blood dyscrasias (HR 1.4, 95 % CI 1.4-1.5). For the antiplatelet model, the most significant predictors of mortality were antiplatelet omission (HR 3.7, 95 % CI 3.3-4.1), liver disease (HR 1.6, 95 % CI 1.4-1.7), malignant/benign neoplasms (HR 1.6, 95 % CI 1.5-1.6), gastrointestinal or respiratory tract intubations (HR 1.5, 95 % CI 1.3-1.7), and blood dyscrasias (HR 1.4, 95 % CI 1.4-1.5). These mortality risk factors may guide future studies assessing potential benefits of antithrombotics in specific subsets of patients.
KW - Anticoagulants
KW - Antiplatelet agents
KW - Medical patients
KW - Mortality
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=84943188979&partnerID=8YFLogxK
U2 - 10.1160/TH15-02-0108
DO - 10.1160/TH15-02-0108
M3 - Article
C2 - 26202514
AN - SCOPUS:84943188979
SN - 0340-6245
VL - 114
SP - 685
EP - 694
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 4
ER -