Major bleeding after hospitalization for deep-venous thrombosis

PURPOSE: Most studies of oral anticoagulant-related bleeding have analyzed the incidence of adverse outcomes among patients with a variety of differen t conditions and without any comparison with a control group. We determined the incidence, rime course, and risk factors associated with major bleedin g after hospital discharge among patients with deep-vein thrombosis, and es timated the excess risk of bleeding associated with oral anticoagulant ther apy. METHODS: A total of 22,000 adults were hospitalized in California for 3 or more days with a diagnosis of deep-venous thrombosis between January 1, 199 2, and September 30, 1994. We determined the risk factors associated with r eadmission for bleeding. We compared the incidence of readmission for bleed ing with comparison cohorts of patients with pneumonia or cellulitis who we re matched for age, gender, race, and length of hospital stay. RESULTS: Of 21,250 patients with deep-venous thrombosis who were discharged without bleeding, 1.4% were readmitted for bleeding within 91 days; the ra te was 2.7 times greater In the first 30 days than in the next 61 days. Ris k factors for bleeding included hospitalization with gastrointestinal bleed ing during the previous 18 months (relative hazard [RH] = 2.6, 95% confiden ce interval [CII: 1.6 to 4.1), hospitalization with an alcohol-related diag nosis during the previous 18 months (RI-I = 2.6, 95% CI: 1.4 to 4.8), chron ic renal disease(RH = 2.4, 95% CI: 1.4 to 4.2), female gender (RH = 1.7, 95 % CI: 1.3 to 2.2), presence of a malignancy (RH = 1.6, 95% CI: 1.2 to 2.2), nonwhite race (RH = 1.6, 95% CI: 1.2 to 2.1), and age over 65 years (RFI = 1.3, 95% CI: 1.0 to 1.7). Significantly more women (n = 40) had intracrani al bleeding than men (n = 18, P = 0.02). In the comparison cohorts, the inc idence of readmission for bleeding within 3 months of discharge was 0.7%, a nd the relative risk (RR) of readmission was greater in those with deep-ven ous thrombosis than in those with cellulitis (RR = 2.0, 95% CI: 1.6 to 2.5) or pneumonia (RR = 2.0, 95% CI: 1.7 to 2.5). CONCLUSIONS: The incidence of rehospitalization for bleeding was greatest i n the first 30 days after discharge, and was approximately twice that seen in patients hospitalized for cellulitis or pneumonia. Further studies are n eeded to determine why women and nonwhite patients are at increased risk fo r anticoagulant-related bleeding. Am J Med. 1999;107:414-424. (C) 1999 by E xcerpta Medica, Inc.