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

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. 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.