Temporal Changes in Hospital-Captured 90-Day Care After Venous Thromboembolism: A 16-Year Electronic Health Record Cohort Study

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Background: Direct oral anticoagulants (DOACs) have simplified treatment for venous thromboembolism (VTE), but fewer mandatory monitoring visits may reduce opportunities for structured reassessment. We evaluated temporal changes in hospital-captured documentation of post-VTE care processes during the transition to DOAC-based treatment, including initial anticoagulation, clinical follow-up, laboratory monitoring, and selective imaging reassessment. Methods: We conducted a single-center retrospective electronic health record cohort study using routinely collected vascular surgery outpatient and inpatient records from Peking University People’s Hospital between 2009 and 2024. Patients with VTE-related evidence and a definable hospital-captured index date were included. Treatment eras were prespecified as 2009– 2014, 2015– 2019, and 2020– 2024. The study-defined documentation measure comprised therapeutic anticoagulation within 14 days and clinical follow-up, laboratory monitoring, and selective VTE-related ultrasound or imaging reassessment within 15– 90 days. Results: Among 5998 patients with a definable hospital-captured index VTE-related event, the median age was 64.0 years, and 55.3% were female. Documented anticoagulation within 14 days increased from 34.1% in 2009– 2014 to 58.0% in 2020– 2024. Within 15– 90 days, clinical follow-up was documented in 1483 patients (24.7%), laboratory monitoring in 366 (6.1%), and VTE-related ultrasound or imaging reassessment in 578 (9.6%). All four prespecified domains were documented in 149 patients (2.5%) overall and in 3.2% during 2020– 2024. In multivariable analysis, the 2020– 2024 era, pulmonary embolism presentation, and upper-extremity or catheter-related VTE were associated with higher odds of four-domain documentation completion. Conclusion: In this 16-year electronic health record cohort, hospital-captured documentation of early anticoagulation increased, whereas documentation of 90-day follow-up processes remained infrequent; incomplete documentation or care delivered outside the hospital system may have contributed. These findings highlight opportunities to strengthen continuity and traceability of post-VTE management through timely clinical review and individualized decisions regarding treatment duration, safety monitoring, and selective imaging when clinically indicated. Keywords: venous thromboembolism, direct oral anticoagulants, anticoagulation management, follow-up care, vascular disease management, real-world evidence

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