Disparities in venous thromboembolism management in patients with sickle cell disease: A nationwide inpatient sample study

Abstract Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a substantial but underappreciated problem in sickle cell disease (SCD) patients. Despite the hypercoagulable state associated with SCD, national patterns of VTE diagnosis, management, and outcomes in this population are still poorly understood, particularly across racial, regional, and hospital-level variables. Objective: To evaluate disparities in the diagnosis and management of VTE among hospitalized patients with sickle cell disease using a nationally representative dataset. Methods: We conducted a retrospective study from 2019 to 2021 using the National Inpatient Sample (NIS), identifying hospitalizations with a main or secondary diagnosis of sickle cell disease (ICD-10 D57.x) and a co-diagnosis of VTE (ICD-10 I26.x, I82.x, I80.x). Patient demographics (age, gender, race, income quartile, insurance) were explored, as were hospital aspects (region, teaching status), and VTE-related treatment (inferior vena cava [IVC] filter installation, systemic anticoagulation, thrombolysis). Multivariable logistic regression was used to identify predictors of intervention usage and in-hospital mortality while accounting for comorbidities and hospital-level characteristics. National figures were determined using survey weights. Results: African American patients accounted for 88.1% of the estimated 18,672 SCD and VTE hospitalizations, with a median age of 33 years. African American patients had reduced chances of obtaining anticoagulant medication (aOR 0.72, 95% CI 0.61-0.84, p<0.001) and higher odds of IVC filter installation (aOR 1.34, 95% CI 1.12-1.61, p=0.002). Patients treated at non-teaching or Southern US institutions were also much less likely to get systemic anticoagulation. In-hospital mortality was 2.3% overall but higher among those not on anticoagulation (4.9% vs. 1.8%, p<0.001). Medicaid recipients were less likely to get thrombolysis in instances of PE (aOR 0.68, 95% CI 0.51-0.89, p=0.005) than commercially insured patients. Conclusions: There are significant racial and institutional disparities in the treatment of VTE among hospitalized sickle cell patients in the United States. African American patients and those treated at non-teaching or Southern facilities were less likely to get evidence-based anticoagulants. These changes may have negative consequences, including increased mortality. Our results show the need for standardized VTE treatment procedures and targeted quality improvement initiatives to ensure fairness in care for people with SCD.