Anticoagulation and other risk factors for clinically relevant bleeding after medical hospitalization: the Medical Inpatient Thrombosis and Hemostasis Study

Abstract

Background

Clinically relevant bleeding after discharge from a medical hospitalization is associated with increased morbidity and mortality. There is limited knowledge of the risk factors for this bleeding.

Objectives

We aimed to determine the risk factors for bleeding leading to rehospitalization after hospital discharge.

Methods

The study population consisted of primary care patients followed longitudinally from October 2010 to September 2019 for medical hospitalization and clinically relevant bleeding. People discharged alive from a medical hospitalization were followed for up to 90 days for postdischarge bleeding requiring rehospitalization. Age-, sex- (male vs female), and length of stay–adjusted hazard ratios for candidate bleeding risk factors were estimated using Cox proportional hazards models.

Results

Over 9 years, there were 15 630 medical hospitalization discharges and 414 (2.6%) postdischarge clinically relevant bleeding events that required readmission. Clinical and patient factors related to the postdischarge bleeding risk were increasing age, active cancer, liver disease, creatinine concentration of >2 g/dL, heart disease, and history of previous gastrointestinal or central nervous system bleeding. Hemoglobin concentrations of <12 g/dL for women and <13.6 g/dL for men, a platelet count of <50 × 10³ mm³, and anticoagulation at discharge were also associated with an increased risk for clinically relevant bleeding postdischarge.

Conclusion

Postdischarge bleeding requiring hospitalization occurs in 2.6% of medical hospitalizations and has objective and readily identifiable risk factors. Findings suggest that clinically relevant bleeding postdischarge may be predictable and quantifiable, which could help increase the safety of anticoagulation decisions at discharge.