Thrombotic complications in patients with acquired factor deficiency: A national inpatient sample analysis

Abstract Introduction: Acquired factor deficiency (AFD) represents a heterogeneous group of rare coagulopathies characterized by decreased levels of one or more coagulation factors due to non-inherited causes, including autoimmune disorders, malignancies, medications, and systemic diseases. While traditionally associated with bleeding diatheses, emerging evidence suggests that AFD patients may paradoxically experience thrombotic complications through mechanisms including inflammatory dysregulation, endothelial dysfunction, and compensatory prothrombotic states. Methods: We conducted our study using the National Inpatient Sample (NIS) database from 2018-2022, the largest publicly available all-payer inpatient healthcare database in the United States. Adult hospitalizations (≥18 years) with a diagnosis of AFD were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Baseline demographics and the prevalence of thrombotic complications—venous, including deep vein thrombosis (DVT), acute pulmonary embolism (PE), and arterial, including acute coronary syndrome (ACS), and acute ischemic stroke—were analyzed. Chi-square and t-tests were used for categorical and continuous variables, respectively. Multivariate logistic regression was performed to assess the association of thrombotic events with in-hospital mortality and length of stay. Results: A total of 411,975 AFD-related hospitalizations were identified, with a mean age of 77 years; 40% were female. The racial distribution was 66% White, 15% Black, 12% Hispanic, and 7% of other ethnicities. Thrombotic complications included DVT (2.39%), PE (1.55%), ACS (2.48%), and acute ischemic stroke (1.46%). Multivariate analysis revealed that the presence of thrombotic events was significantly associated with higher odds of in-hospital mortality (odds ratio (OR)-1.97; C.I: 1.85-2.10; P<0.001) and increased length of stay (OR-5.63; C.I: 5.12-6.14; P<0.001). Conclusion: Although AFD is uncommon, thrombotic complications occur in a notable subset of patients and are associated with worse outcomes and increased healthcare utilization in terms of length of stay. Improved awareness of prevalence of thrombosis is required as patients with AFD are frequently less likely to receive pharmacologic venous thromboembolism prophylaxis during hospitalization, often due to concerns regarding the heightened risk of hemorrhagic complications.