Pharmacy Department, Rotunda Hospital, Dublin, Ireland.
Division of Population Health Sciences, Royal College of Surgeons, Dublin, Ireland.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):6353-6355. doi: 10.1080/14767058.2021.1912000. Epub 2021 Apr 15.
Obstetric venous thromboembolism (VTE) is a leading cause of maternal mortality. While hospital discharge data provide a readily accessible means of studying this relatively rare outcome, diagnosis codes are of limited validity. Prior studies have demonstrated that VTE billing codes may be subject to misclassification and false positives and overestimate obstetric VTE risk. Given the public health significance of accurately estimating obstetric VTE, the purpose of this study was to determine to what degree patients received anticoagulants after discharge from a delivery hospitalization associated with an acute VTE diagnosis as pharmacy claims may more accurately assess the incidence of obstetric VTE.
A retrospective cohort study using the MarketScan database was performed using 2008-2014 claims data. We identified women 15-54 years of age diagnosed with acute VTE during a delivery hospitalization. We determined the proportion of women with VTE that received anticoagulants within 60 days of delivery discharge. Only women with ≥60 days of pharmacy benefits after discharge were included. Receipt of low molecular weight and unfractionated heparin, warfarin, and Xa inhibitors was ascertained. Receipt of anticoagulants was analyzed individually based on diagnoses for deep vein thrombosis (DVT), pulmonary embolism (PE), or both. The Chi-square test was performed for categorical comparisons.
Of 2,664,951 delivery hospitalizations, 2112 women had a diagnosis of VTE (0.08%) including 236 women with PE alone, 1760 women with DVT alone, and 116 women with both DVT and PE. Of these women, 51.3% (95% CI 49.2-53.4%) received an anticoagulant including 49.5% of women with DVT (95% CI 47.2-51.8%), 50.0% of women with PE (95% CI 43.7-56.3%), and 81.9% of women with both DVT and PE (95% CI 73.9-87.9%).
This analysis of pharmacy claims found that estimates for the proportion of deliveries with acute VTE diagnoses that subsequently received anticoagulants was similar to chart-confirmed VTE, albeit in a large population. In addition to previous studies comparing database claims to chart review that showed that the prevalence of VTE was grossly overestimated, these findings support that the proportion of cases with VTE during delivery hospitalization may be approximately half that ascertained with billing codes.
产科静脉血栓栓塞症（VTE）是产妇死亡的主要原因。尽管医院出院数据为研究这一相对罕见的结局提供了一种易于获取的手段，但诊断代码的有效性有限。先前的研究表明，VTE 计费代码可能存在分类错误和假阳性，并高估了产科 VTE 的风险。鉴于准确估计产科 VTE 的重要性，本研究旨在确定在与急性 VTE 诊断相关的分娩住院期间出院后，有多少患者接受了抗凝治疗，因为药房索赔可能更准确地评估产科 VTE 的发生率。
本研究采用 MarketScan 数据库进行回顾性队列研究，使用 2008-2014 年的索赔数据。我们确定了在分娩住院期间被诊断为急性 VTE 的 15-54 岁女性。我们确定了 VTE 患者在分娩出院后 60 天内接受抗凝治疗的比例。仅纳入出院后有≥60 天药房福利的女性。确定了接受低分子肝素和普通肝素、华法林和 Xa 抑制剂的情况。根据深静脉血栓形成（DVT）、肺栓塞（PE）或两者的诊断，分别分析接受抗凝治疗的情况。采用卡方检验进行分类比较。
在 2664951 例分娩住院中，有 2112 例女性被诊断为 VTE（0.08%），其中 236 例女性单独患有 PE，1760 例女性单独患有 DVT，116 例女性同时患有 DVT 和 PE。在这些女性中，51.3%（95%CI 49.2-53.4%）接受了抗凝治疗，包括 49.5%（95%CI 47.2-51.8%）的 DVT 女性、50.0%（95%CI 43.7-56.3%）的 PE 女性和 81.9%（95%CI 73.9-87.9%）的 DVT 和 PE 女性。
这项对药房索赔的分析发现，接受抗凝治疗的急性 VTE 诊断分娩比例的估计与图表确认的 VTE 相似，尽管是在一个大人群中。除了先前的研究比较数据库索赔与图表审查，表明 VTE 的患病率被严重高估外，这些发现支持在分娩住院期间 VTE 病例的比例可能大约是计费代码确定的一半。
