Association of opioid use disorder and thrombotic events in hospitalized patients: A national inpatient database study

Abstract Introduction Thrombotic events, such as deep vein thrombosis (DVT), pulmonary embolism (PE), and arterial thrombosis, are serious complications in hospitalized patients. Those who develop these conditions have been found to be at increased risk of detrimental outcomes, such as early mortality. Prompt identification of risk factors for thrombosis is crucial for guiding therapy and optimizing patient management. The literature is sparse with regards to the association of opioid use disorder (OUD) and thrombosis. Due to the prevalence of opioid related hospitalizations, it is increasingly important to understand this association. Methods We conducted a cross-sectional study using the 2018 National Inpatient Sample (NIS) database to assess the prevalence of thrombotic events among adult (age > 18 years) hospitalizations with and without OUD. Comorbidities, OUD, and thrombotic events, were identified using ICD-10-CM codes. The charlson comorbidity index was used to compare comorbidities. Significance of descriptive data was determined by chi square tests. Multivariable logistic regression was used to evaluate the association between OUD and thrombotic events, adjusting for demographics, comorbidities, and clinical risk factors. National estimates were generated using survey weights. Results: Among 29,342,703 weighted hospitalizations, 731,240 (2.6%) involved OUD. Patients with OUD were younger (mean age 46.8 vs. 58.5 years), more likely to be male (51.4% vs. 42.4%), and had higher rates of Medicaid insurance (44.1% vs. 17.6%) compared to non-OUD hospitalizations (all p<0.00001). Prevalence of thrombotic events was significantly higher in OUD patients: PE: 1.9% vs. 1.3%, arterial thrombosis: 0.3% vs. 0.2% (all p<0.00001). After adjustment, OUD was independently associated with increased odds of DVT (aOR 1.22, 95% CI: 1.17–1.26) and PE (aOR 1.63, 95% CI: 1.56–1.69), but not arterial thrombosis (aOR 0.94, 95% CI: 0.85–1.05). Conclusions Based on our analysis, OUD was independently associated with significantly increased odds of DVT and PE, even after adjusting for demographic and potential clinical confounders. However, OUD was not associated with arterial thrombosis after multivariable regression. This study highlights the potential of OUD as an underappreciated risk factor for venous thromboembolism. Future studies are warranted to determine whether targeted strategies are beneficial in this population.