Impact of an integrated hospital-community care pathway on the management of venous thromboembolism: the venous thromboembolic disease care pathway 93 study.
Datchanamourty J, Morabito A, et al. • Research and practice in thrombosis and haemostasis • 2026
A structured city-hospital care pathway for venous thromboembolism was associated with a lower risk of composite complications (HR 0.44) and markedly lower loss-to-follow-up rates compared with standard care in a medically underserved area.
Key Findings
Results
Enrollment in a structured hospital-community care pathway was associated with a significantly lower risk of the primary composite endpoint of thrombotic recurrence, bleeding, hospitalization, or death.
Hazard ratio of 0.44 (95% CI, 0.21–0.93; P = .03) favoring the structured pathway
Result was consistent after inverse probability of treatment weighting analysis (HR, 0.44; 95% CI, 0.21–0.92; P = .03)
Study population: 161 consecutive patients managed for VTE at Avicenne Hospital (Bobigny, France) from December 2022 to December 2024
Structured pathway group included 64 patients; standard care group included 97 patients
Loss to follow-up was markedly lower in the structured pathway group compared with the standard care group.
Loss to follow-up rate was 7.8% in the structured pathway group versus 30% in the standard care group (P = .002)
Enrollment in the pathway was associated with lower odds of loss to follow-up (odds ratio, 0.21; 95% CI, 0.07–0.53; P = .002)
This represents a nearly 4-fold difference in loss-to-follow-up rates between groups
Results
Patients lost to follow-up had a substantially higher risk of complications compared with those who remained in follow-up.
Hazard ratio for complications among patients lost to follow-up was 3.50 (95% CI, 1.71–7.18; P < .001)
This represents a 3.5-fold higher risk of the composite endpoint for patients lost to follow-up
The finding highlights loss to follow-up as a clinically significant risk factor in VTE management
Background
The study was conducted in a medically underserved area where care transitions represent a particularly vulnerable period for VTE patients.
The study site was Avicenne Hospital in Bobigny, France, described as a medically underserved area
The authors note that 'loss to follow-up is common' in such settings during care transitions
Patients were managed in a day hospital setting over a two-year period (December 2022 to December 2024)
Methods
Inverse probability of treatment weighting was employed to address potential confounding between the structured pathway and standard care groups.
The retrospective, non-randomized design necessitated statistical adjustment for baseline differences between groups
Results after weighting were consistent with the unweighted analysis (HR, 0.44; 95% CI, 0.21–0.92; P = .03)
The consistency of results before and after weighting strengthens confidence in the observed association
What This Means
This research suggests that organizing care for patients with blood clots (venous thromboembolism, or VTE) through a structured program that connects hospital and community healthcare providers can meaningfully improve patient outcomes. In this study conducted at a hospital in a disadvantaged area of France, patients enrolled in a structured care pathway were about half as likely to experience serious complications—such as a new blood clot, a bleeding event, hospitalization, or death—compared to patients receiving usual care. The study followed 161 patients over two years and used statistical methods to account for differences between the two groups.
A particularly notable finding was how much the structured pathway reduced the number of patients who fell out of contact with their healthcare providers. In the standard care group, nearly 1 in 3 patients (30%) was lost to follow-up, compared to fewer than 1 in 13 (7.8%) in the structured pathway group. Patients who were lost to follow-up had 3.5 times the risk of experiencing serious complications compared to those who stayed engaged with care, underscoring why maintaining contact is so important for this patient population.
This research suggests that building formal coordination between hospitals and community-based healthcare providers—especially in areas with limited medical resources—could be an important tool for keeping VTE patients safe after their initial treatment. The findings point to loss of follow-up as both a common problem and a significant driver of harm in VTE management, and suggest that structured pathways may be a practical way to address this vulnerability. Because this was a single-center retrospective study, larger and more rigorous studies would be needed to confirm these findings more broadly.
Datchanamourty J, Morabito A, Lhote R, Hammami S, Sritharan N, Plichart M, et al.. (2026). Impact of an integrated hospital-community care pathway on the management of venous thromboembolism: the venous thromboembolic disease care pathway 93 study.. Research and practice in thrombosis and haemostasis. https://doi.org/10.1016/j.rpth.2026.106956