The Association Between Group Identity and Advanced Therapies in a Cohort of Patients Hospitalized with Venous Thromboembolic Disease: The Medical Inpatient Thrombosis and Hemostasis (MITH) Study.

Background: The mainstay therapy for venous thromboembolism (VTE) is anticoagulation but advanced therapies as systemic thrombolysis or catheter-directed thrombolysis (CDT), extracorporeal membrane oxygenation (ECMO), and surgical or catheter-guided thrombectomy, are used in eligible patients. There is a dearth of studies evaluating group identity-based disparities, driven by systemic discrimination, in the use of advanced therapies and clinical outcomes in patients with VTE. Methods: We conducted a cohort study of patients hospitalized for ≥24 hours on a medical service and aged ≥18 years with a first hospitalization with a present-on-admission VTE diagnosis between 2016 and 2022 in 3 medical centers in the United States. Group identity was defined as Asian, Black, Hispanic or Latino, White, or Other identity. The primary outcome was the use of advanced therapies, defined as the use of systemic thrombolytics, CDT, surgical thrombectomy, catheter-guided thrombectomy, or ECMO. Our primary analysis evaluated the association between group identity and use of advanced therapies using multivariable logistic regression to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI), controlling for comorbidities and sociodemographic, clinical, and laboratory variables at baseline. Secondary exploratory analyses evaluated the association of group identity with inferior vena cava filter placement, with in-hospital mortality, and with length of hospital stay. Results: A total of 7,809 patients were included with Asian (<1%), Black (30%), Hispanic or Latino (8%), Other (5%), and White (56%) identities. Overall, 615 (8%) patients were treated with advanced therapies. In the main analysis, Asian (OR = 0.69, 95% CI: 0.24, 1.96), Black (OR = 1.02, 95% CI: 0.83, 1.26), Hispanic or Latino (OR = 0.77, 95% CI: 0.55, 1.08), and Other (OR = 0.84, 95% CI: 0.56, 1.26) identities were not associated with use of advanced therapies compared with White identity after controlling for comorbidities and sociodemographic, clinical, and laboratory variables at baseline. In secondary exploratory analyses, Hispanic or Latino (OR = 1.69, 95% CI: 1.11, 2.58) identity was associated with placement of inferior vena cava filters compared with White identity. Furthermore, Asian (OR = 2.32, 95% CI: 1.06, 5.06) identity was associated with higher in-hospital mortality compared with White identity. We did not find an association between group identity and length of hospital stay.

Conclusions: We did not find evidence of group-identity based disparities in the use of advanced therapies for VTE. Additional well-powered studies evaluating disparities in the use of advanced therapies, inferior vena cava filters, and clinical outcomes in patients hospitalized with VTE are required.