Language
English
Publication Date
11-1-2024
DOI
10.1016/j.jtha.2024.07.025
PMID
39128654
Abstract
Background: Inpatient and extended postdischarge thromboprophylaxis of COVID-19 patients remains suboptimal despite antithrombotic guidelines.
Objectives: To determine whether a novel electronic health record-agnostic clinical decision support (CDS) tool incorporating the International Medical Prevention Registry on Venous Thromboembolism plus D-dimer (IMPROVE-DD) venous thromboembolism (VTE) scores increases appropriate inpatient and extended postdischarge thromboprophylaxis and improves outcomes in COVID-19 inpatients.
Methods: This post hoc analysis of the IMPROVE-DD cluster randomized trial evaluated thromboprophylaxis CDS among COVID-19 inpatients at 4 New York hospitals between December 21, 2020, and January 21, 2022. Hospitals were randomized 1:1 to CDS (intervention, n = 2) vs no CDS (usual care, n = 2). The primary outcome was rate of appropriate thromboprophylaxis. Secondary outcomes included rates of major thromboembolism, all-cause and VTE-related readmissions and death, major bleeding (MB), and all-cause mortality 30 days after discharge.
Results: Two thousand four hundred fifty-two COVID-19 inpatients were analyzed (CDS, 1355; no CDS, 1097). Mean age was 73.7 ± 9.37 years; 50.1% of participants were male. CDS adoption was 96.8% (intervention group). CDS was associated with increased appropriate at-discharge extended thromboprophylaxis (42.6% vs 28.8%; odds ratio [OR], 1.83; 95% CI, 1.39-2.41; P < .001). CDS was associated with reduced VTE (OR, 0.54; 95% CI, 0.39-0.75; P < .001), arterial thromboembolism (OR, 0.10; 95% CI, 0.01-0.81; P = .01), total thromboembolism (OR, 0.50; 95% CI, 0.36-0.69; P < .001), and 30-day all-cause readmission/death (OR, 0.78; 95% CI, 0.62-0.99; P = .04). There were no differences in MB, VTE-related readmissions/death, or all-cause mortality.
Conclusion: Electronic health record-agnostic CDS incorporating IMPROVE-DD VTE scores had high adoption, was associated with increased appropriate at-discharge extended thromboprophylaxis, and reduced thromboembolism and all-cause readmission/death without increasing MB in COVID-19 inpatients.
Keywords
Humans, COVID-19, Male, Female, Venous Thromboembolism, Aged, Decision Support Systems, Clinical, Middle Aged, Electronic Health Records, Fibrin Fibrinogen Degradation Products, Anticoagulants, SARS-CoV-2, Hospitalization, Patient Discharge, Hemorrhage, Treatment Outcome, Aged, 80 and over, Inpatients, New York, Risk Factors, Patient Readmission, COVID-19, clinical decision support, health informatics, prophylaxis, thrombosis
Published Open-Access
yes
Recommended Citation
Goldin, Mark; Tsaftaridis, Nikolaos; Koulas, Ioannis; et al., "Universal Clinical Decision Support Tool for Thromboprophylaxis in Hospitalized COVID-19 Patients: Post Hoc Analysis of the Improve-Dd Cluster Randomized Trial" (2024). Faculty and Staff Publications. 4522.
https://digitalcommons.library.tmc.edu/baylor_docs/4522
Included in
Clinical Epidemiology Commons, COVID-19 Commons, Health Services Research Commons, Medical Sciences Commons, Medical Specialties Commons