Randomized trial of physician alerts for thromboprophylaxis after discharge
Center for Outcomes Research; Department of Surgery
Medical Subject Headings
Venous Thromboembolism; Venous Thrombosis; Pulmonary Embolism
Cardiology | Cardiovascular Diseases | Health Services Research
BACKGROUND: Many hospitalized Medical Service patients are at risk for venous thromboembolism in the months after discharge. We conducted a multicenter randomized controlled trial to test whether a hospital staff member's thromboprophylaxis alert to an Attending Physician before discharge will increase the rate of extended out-of-hospital prophylaxis and, in turn, reduce the incidence of symptomatic venous thromboembolism at 90 days.
METHODS: From April 2009 to January 2010, we enrolled hospitalized Medical Service patients using the point score system developed by Kucher et al to identify those at high risk for venous thromboembolism who were not ordered to receive thromboprophylaxis after discharge. There were 2513 eligible patients from 18 study sites randomized by computer in a 1:1 ratio to the alert group or the control group.
RESULTS: Patients in the alert group were more than twice as likely to receive thromboprophylaxis at discharge as controls (22.0% vs 9.7%, P <.0001). Based on an intention-to-treat analysis, symptomatic venous thromboembolism at 90 days (99.9% follow-up) occurred in 4.5% of patients in the alert group, compared with 4.0% of controls (hazard ratio 1.12; 95% confidence interval, 0.74-1.69). The rate of major bleeding at 30 days in the alert group was similar to that of the control group (1.2% vs 1.2%, hazard ratio 0.94; 95% confidence interval, 0.44-2.01).
CONCLUSIONS: Alerting providers to extend thromboprophylaxis after hospital discharge in Medical Service patients increased the rate of prophylaxis but did not decrease the rate of symptomatic venous thromboembolism.
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Citation: Piazza G, Anderson FA, Ortel TL, Cox MJ, Rosenberg DJ, Rahimian S, Pendergast WJ, McLaren GD, Welker JA, Akus JJ, Stevens SM, Elliott CG, Freeman AL, Patton WF, Dabbagh O, Wyman A, Huang W, Rao AF, Goldhaber SZ. Randomized trial of physician alerts for thromboprophylaxis after discharge. Am J Med. 2013 May;126(5):435-42. doi: 10.1016/j.amjmed.2012.09.020.
Piazza, Gregory; Anderson, Frederick A. Jr.; Ortel, Thomas L.; Cox, Michael J.; Rosenberg, David J.; Rahimian, Shahram; Pendergast, William J.; McLaren, Gordon D.; Welker, James A.; Akus, Jan J.; Stevens, Scott M.; Elliott, C. Gregory; Freeman, Andrew L.; Patton, William F.; Dabbagh, Ousama; Wyman, Allison; Huang, Wei; Rao, Amanda F.; and Goldhaber, Samuel Z., "Randomized trial of physician alerts for thromboprophylaxis after discharge" (2013). Other Center for Outcomes Research Publications. Paper 3.