# Bridging the post-discharge management gap in venous thromboembolism: linking adherence patterns to persistent hypercoagulability

## TL;DR

This study shows that poor adherence to post-discharge VTE care is linked to ongoing blood clot risk, suggesting a need for long-term management strategies.

## Contribution

The study establishes a direct biological link between post-discharge adherence and persistent hypercoagulability in VTE patients.

## Key findings

- Non-adherent patients showed minimal D-dimer reduction compared to those with complete adherence.
- Current smoking was the strongest predictor of sustained D-dimer elevation.
- A critical adherence decline occurred around 60 days post-discharge, coinciding with elevated recurrence risk.

## Abstract

This observational study investigates the relationship between post-discharge adherence to venous thromboembolism (VTE) preventive measures (including anticoagulant therapy, compression therapy, and follow-up attendance) and the resolution of hypercoagulability, as assessed through serial D-dimer measurements. It is important to note that clinical recurrence outcomes were not directly measured in this study; the primary endpoint was biomarker trajectory.

Conducted at a tertiary vascular surgery department in Changsha, China, between April and September 2024, this prospective cohort study enrolled 110 patients with confirmed VTE diagnoses. Participants were stratified into three adherence categories based on their post-discharge compliance with prescribed anticoagulation and compression therapies using objective criteria of treatment completion and self-reported behavior: complete adherence (Group A, n = 40), partial adherence (Group B, n = 44), and non-adherence (Group C, n = 26). We measured D-dimer levels at diagnosis and at the 90-day follow-up, calculating absolute changes (ΔD-dimer = D-dimerfollow-up—D-dimerbaseline) to evaluate resolution of hypercoagulability. Statistical analyses employed ANOVA for group comparisons and multivariable linear regression to identify predictors of persistent D-dimer elevation.

Only 38.4% of patients maintained consistent use of elastic stockings throughout the 90-day follow-up period, with adherence declining most substantially between 30 and 60 days post-discharge. D-dimer trajectories revealed marked intergroup differences: patients in the non-adherence group demonstrated minimal reduction in D-dimer levels (Δ −0.52 μg/mL; 95% CI: −1.46–0.42), whereas those in the complete adherence group showed substantial decreases (Δ −4.87 μg/mL; 95% CI: −5.92 to −3.82; p < 0.001). Current smoking emerged as the strongest independent predictor of sustained D-dimer elevation (β = 6.121, p < 0.001), followed by non-adherence status (β = 4.991, p < 0.001). The period around 60 days post-discharge represented a critical “adherence cliff” that coincides with established windows of elevated recurrence risk, though this link is inferential based on biomarker data rather than observed clinical events.

Our findings establish a direct biological link between the post-discharge “management gap” in VTE care and persistent hypercoagulability. We propose reframing VTE as a chronic high-risk condition necessitating structured long-term management, with particular emphasis on interventions targeting the 60-day transition period and smoking cessation as high-yield strategies. These insights advocate for a paradigm shift from acute treatment to sustained risk control in VTE management.