Association of pharmacological thromboprophylaxis with clinically relevant bleeding and hospital-acquired anemia in medical inpatients: The RISE study.

Choffat, Damien; Rossel, Jean-Benoît; Aujesky, Drahomir; Vollenweider, Peter; Baumgartner, Christine; Méan, Marie (2024). Association of pharmacological thromboprophylaxis with clinically relevant bleeding and hospital-acquired anemia in medical inpatients: The RISE study. Journal of thrombosis and haemostasis, 22(3), pp. 765-774. Wiley 10.1016/j.jtha.2023.11.021

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INTRODUCTION

Pharmacological thromboprophylaxis (pTPX) might exacerbate the risk of clinically relevant bleeding (CRB) and hospital-acquired anemia (HAA) in older multimorbid inpatients. We aimed to evaluate the association of pTPX use with CRB and HAA.

METHODS

We used data from a prospective cohort study conducted in three Swiss hospitals. Adult patients admitted to internal medicine wards with no therapeutic anticoagulation were included. pTPX use was ascertained during hospitalization. Outcomes were in-hospital CRB and HAA. We calculated incidence rates by status of pTPX. We assessed the association of pTPX with CRB using survival analysis and HAA using logistic regression, adjusted for infection, length of stay and IMPROVE Bleeding risk score.

RESULTS

Among 1305 patients (mean age 63.7 years; 44% women, 90% at low risk of bleeding), 809 (62%) received pTPX. Incidence of CRB was 2.4 per 1000 patient-days and was not significantly higher in patients with pTPX vs without. We found no significant association between pTPX and CRB. HAA was frequent (20.2%) and higher in patients with pTPX vs without (23.2% vs 15.3%). Incidence of HAA was 21.2 per 1000 patient-days and did not significantly differ in patients with pTPX vs without. We found an association between pTPX and HAA (adjusted OR 1.4, 95% CI: 1.0 - 2.1).

CONCLUSION

Our study confirms the safety of pTPX in medical inpatients at low risk of bleeding but identifies an association between pTPX and HAA. Adherence to guidelines that recommend administering pTPX to medical inpatients at increased VTE risk and low bleeding risk is necessary.

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