Post amended 5/25/22 11am. PERC considers recent surgery or trauma in the past 28 days, not necessarily hospitalization.
Written by Clay Smith
Risk for venous thromboembolism (VTE) was highest during hospitalization, but the risk remained elevated 3-fold at 3 months post-discharge.
Why does this matter?
The PERC rule considers recent surgery or trauma in the past 28 days as a risk factor for VTE. But what about a recent hospitalization 60 or even 90 days ago? Is that patient still at increased risk of VTE?
Hospitals are clot factories
This was a retrospective study of primary care patients in the University of Vermont health system. 82,735 primary care patients were observed in the Epic electronic health record over the study period and followed for about 4 years; this was a total of 354,022 person-years, and there were 55,173 hospitalizations. This was the only hospital in the area, so it was unlikely major medical events would have not been captured in follow up. During this time, 713 VTE events occured, a rate of 2/1000 person-years. The rate of VTE was 1.4/1000 person-years among patients with no recent hospitalization. That jumped to 71.8/1000 person-years when hospitalized; rates were 35.1, 11.3, and 5.2 per 1,000 person-years at 1, 2, and 3 months after discharge, respectively. The adjusted hazard ratios were 38.0 during the hospital stay and 18.4, 6.3, and 3.0 at 1, 2, and 3 months after discharge, respectively. Risk was nearly the same whether patients were medical or surgical.
This study shows us that the biggest risk for VTE occurs during the hospital stay, but there is still a 3-fold increased risk up to 3 months from the time of hospital discharge. The PERC rule will catch many of these who’ve had surgery or trauma in the past 28 days, but we should probably think in gradations of risk based on recent hospital discharge.
Venous Thrombosis Risk during and after Medical and Surgical Hospitalizations: The Medical Inpatient Thrombosis and Hemostasis (MITH) Study. J Thromb Haemost. 2022 Apr 15. doi: 10.1111/jth.15729. Online ahead of print.