, Volume 32, Issue 3, pp 305–313 | Cite as

Treatment, Monitoring, and Economic Outcomes of Venous Thromboembolism Among Hospitalized Patients in China

  • Eric Q. WuEmail author
  • Jipan Xie
  • Chun Wu
  • Ella Xiaoyan Du
  • Nanxin Li
  • Ruoding Tan
  • Yuanli Liu
Original Research Article



The prevalence of venous thromboembolism (VTE) has been increasing in China. However, the treatment pattern and economic burden of these patients have not been well-understood.


The objective of this study was to examine the patient characteristics, treatment pattern, anticoagulant monitoring, and economic burden of VTE among hospitalized patients in China.


Hospitalizations with a diagnosis of VTE [including deep vein thrombosis (DVT) or pulmonary embolism (PE)] between 1 January 2010 and 30 June 2013 were included. Descriptive analysis was conducted for patients’ characteristics, anticoagulant treatment, international normalized ratio (INR) monitoring, and hospitalization cost [in 2013 Chinese yuan (Y) and US dollars (US$)]. Multivariate regressions were performed to assess factors associated with oral anticoagulant use and total costs of inpatient care.


A total of 1,047 VTE-related hospitalizations were selected. The sample had a mean age of 62.4 years, with 45.9 % female. About 46.3 % of hospitalizations used heparin only, 35.0 % used warfarin, 0.8 % used rivaroxaban, and 18.0 % did not use anticoagulants. Among hospitalizations where warfarin was used, 90.8 % received at least one INR test and only 30 % had the last INR within the target therapeutic range (2–3) before discharge. The mean (standard deviation) total cost per hospitalization was Y29,114 (43,772) [US$4,757 (7,152)]. PE, VTE as primary diagnosis, female, insurance coverage, anticoagulant treatment, co-morbidities, admission condition, and surgical procedure were significantly associated with inpatient costs.


Conventional anticoagulants were most commonly used in the study sample. Under-monitoring and suboptimal care may be an issue for patients treated with warfarin. The average total inpatient cost of VTE-related hospitalizations is high.


Warfarin Pulmonary Embolism Deep Vein Thrombosis International Normalize Ratio Rivaroxaban 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This research has been financially supported by Analysis Group, Inc. The authors independently conducted all analyses and wrote the manuscript. The authors controlled the decision to write and submit the manuscript for publication. EQW, JX, EXD, NL, and RT are employees of Analysis Group, Inc.

Authors’ contributions

EQW, JX, EXD, NL, RT, and YL designed the study. EXD, NL, and RT conducted the main analyses. CW, EQW, and JX played a key role in interpreting the data analysis. All authors contribute to drafting and revising the manuscript. EQW, JX, CW, EXD, NL, RT, and YL played a key role in the study conduct and data collection for the analysis used in this manuscript. EQW is the guarantor of the paper.


  1. 1.
    Burnett B. Management of venous thromboembolism. Prim Care. 2013;40(1):73–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Garcia P, Ruiz W, Loza Munarriz C. Warfarin initiation nomograms for venous thromboembolism. Cochrane Database Syst Rev. 2013;7:CD007699.PubMedGoogle Scholar
  3. 3.
    Deitelzweig SB, Johnson BH, Lin J, Schulman KL. Prevalence of clinical venous thromboembolism in the USA: current trends and future projections. Am J Hematol. 2011;86(2):217–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Surgeon General. Surgeon General’s call to action to prevent deep vein thrombosis and pulmonary embolism; 2008. Accessed 10 Oct 2013.
  5. 5.
    Zhai ZG, Zhan X, Yang YH, Wang C. Recent research on venous thromboembolism in China: a brief report from China Venous Thromboembolism Study Group. Chin Med J (Engl). 2010;123(4):485–90.Google Scholar
  6. 6.
    Sun KK, Wang C, Pang BS, Yang YH, He W, Chen TF, et al. Study on the risk factors of deep venous thrombosis in acute hospitalized stroke patients [in Chinese]. Chin J Epidemiol. 2004;25(12):1019–23.Google Scholar
  7. 7.
    Guan ZP, Lu HS, Chen YZ, Song YN, Qin XL, Jiang J. Clinical risk factors for deep vein thrombosis after total hip and knee arthroplasty [in Chinese]. Chin J Surg. 2005;43(20):1317–20.PubMedGoogle Scholar
  8. 8.
    Li XY, Fan J, Cheng YQ, Wang Y, Yao C, Zhong NS. Incidence and prevention of venous thromboembolism in acutely ill hospitalized elderly Chinese. Chin Med J (Engl). 2011;124(3):335–40.Google Scholar
  9. 9.
    Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):7S–47S.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hull R, Hirsh J, Jay R, Carter C, England C, Gent M, et al. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med. 1982;307(27):1676–81.PubMedCrossRefGoogle Scholar
  11. 11.
    Oake N, Jennings A, Forster AJ, Fergusson D, Doucette S, van Walraven C. Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis. CMAJ. 2008;179(3):235–44.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Rivaroxaban Chinese label as approved by China Food and Drug Administration. Accessed 30 Dec 2013.
  13. 13.
    China Thoracic Society. The guideline of diagnosis and treatment of pulmonary thromboembolism in China [in Chinese]. Chin J Tuberc Respir Dis. 2001;24:259–64.Google Scholar
  14. 14.
    China Medical Association. The diagnosis and treatment of deep vein thrombosis [in Chinese]. Chin J Gen Surg. 2008;23(3):235–8.Google Scholar
  15. 15.
    Tsai J, Abe K, Boulet SL, Beckman MG, Hooper WC, Grant AM. Predictive accuracy of 29-comorbidity index for in-hospital deaths in US adult hospitalizations with a diagnosis of venous thromboembolism. PLoS ONE. 2013;8(7):e70061.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    National Bureau of Statistics of China. China Statistical Database; 2013. Accessed 10 Oct 2013.
  17. 17.
    Bloomberg. US Dollar—China RMB exchange rate; 2013. Accessed 10 Oct 2013.
  18. 18.
    Tan XY, He JG, Zou ZP, Zhao YF, Chen BP, Gao Y, et al. Changes of the proportion and mortality of pulmonary thromboembolism in hospitalized patients from 1974 to 2005. Chin Med J (Engl). 2006;119(12):998–1002.Google Scholar
  19. 19.
    Kapoor A, Labonte AJ, Winter MR, Segal JB, Silliman RA, Katz JN, et al. Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the Nationwide Inpatient Sample (2003–2006). BMC Geriatr. 2010;10:63.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Xie Y, Zhang X, Li J, Yu X, Ren Q. China Well-being Development Report 2013. Beijing: Peking University Press; 2013.Google Scholar
  21. 21.
    Wu JJ, Yang L. Analysis of hospitalization costs for 278 venous thromboembolism patients with health insurance in China [in Chinese]. J Peking Univ (Health Sci). 2013;45(3):437–42.Google Scholar
  22. 22.
    Gong IY, Schwarz UI, Crown N, Dresser GK, Lazo-Langner A, Zou G, et al. Genetic determinants of response to warfarin during initial anticoagulation. N Engl J Med. 2008;358(10):999–1008.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Eric Q. Wu
    • 1
    Email author
  • Jipan Xie
    • 2
  • Chun Wu
    • 3
  • Ella Xiaoyan Du
    • 1
  • Nanxin Li
    • 1
  • Ruoding Tan
    • 1
  • Yuanli Liu
    • 4
  1. 1.Analysis Group, Inc.BostonUSA
  2. 2.Analysis Group, Inc.New YorkUSA
  3. 3.Department of CardiologyPeking University Shenzhen HospitalShenzhenChina
  4. 4.Department of Global Health and PopulationHarvard School of Public HealthBostonUSA

Personalised recommendations