Hypoalbuminemia and Its Association With Venous Thromboembolism in Acutely Ill Hospitalized Patients: Findings From the APEX Trial

Background: Decreased serum concentration of albumin, an acute-phase reactant with anticoagulant properties, may be associated with unfavorable prognosis in hospitalized patients. Objectives: The study aims to evaluate the relationship between albumin and venous thromboembolism (VTE) among hospitalized medical patients. Further, we assess the incremental prognostic impact of albumin to well-validated risk assessment models. Methods: The APEX trial randomized 7513 acutely ill hospitalized patients to thromboprophylaxis with betrixaban or enoxaparin. The association of baseline albumin (as continuous or categorical variable) to VTE at 77 days was assessed by fitting logistic regression models. VTE risk refinement was evaluated by incorporation of albumin into the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score and Padua prediction score. Results: Baseline albumin concentrations were obtained in 7266 subjects with evaluable VTE endpoints (median: 39 g/L; interquartile rang...