Effectiveness of Interventions for the Implementation of Thromboprophylaxis in Hospitalised Patients at Risk of Venous Thromboembolism: an Updated Abridged Cochrane Systematic Review and Meta-analysis of Randomised Controlled Trials

Overview

Journal BMJ Open

Specialty General Medicine

Date 2019 May 27

PMID 31129575

Citations 12

Authors

Susan R Kahn

Gisele Diendere

David R Morrison

Alexandre Piche

Kristian B Filion

Adi J Klil-Drori

James Douketis

Jessica Emed

Andre Roussin

Vicky Tagalakis

Martin Morris

William Geerts

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the effectiveness of system-wide interventions designed to increase the implementation of thromboprophylaxis and decrease the incidence of venous thromboembolism (VTE) in hospitalised medical and surgical patients at risk of VTE.

Design: Systematic review and meta-analysis of randomised controlled trials (RCTs).

Data Sources: Medline, PubMed, Embase, BIOSIS, CINAHL, Web of Science, CENTRAL, DARE, EED, LILACS and clinicaltrials.gov without language restrictions from inception to 7 January 2017, as well as the reference lists of relevant review articles.

Eligibility Criteria For Selecting Studies: RCTs that evaluated the effectiveness of system-wide interventions such as alerts, multifaceted, education, and preprinted orders when compared with no intervention, existing policy or another intervention.

Results: We included 13 RCTs involving 35 997 participants. Eleven RCTs had data available for meta-analysis. Compared with control, we found absolute increase in the prescription of prophylaxis associated with alerts (21% increase, 95% CI [15% to 275%]) and multifaceted interventions (4% increase, 95% CI [3% to 11%]), absolute increase in the prescription of appropriate prophylaxis associated with alerts (16% increase, 95% CI [12% to 20%]) and relative risk reductions (risk ratio 64%, 95% CI [47% to 86%]) in the incidence of symptomatic VTE associated with alerts. Computer alerts were found to be more effective than human alerts, and multifaceted interventions with an alert component appeared to be more effective than multifaceted interventions without, although comparative pooled analyses were not feasible. The quality of evidence for improvement in outcomes was judged to be low to moderate certainty.

Conclusions: Alerts increased the proportion of patients who received prophylaxis and appropriate prophylaxis, and decreased the incidence of symptomatic VTE. Multifaceted interventions increased the proportion of patients who received prophylaxis but were found to be less effective than alerts interventions.

Trial Registration Number: CD008201.

Citing Articles

Factors associated with venous thromboembolism pharmacoprophylaxis initiation in hospitalized medical patients: the Medical Inpatients Thrombosis and Hemostasis study.

Repp A, Sparks A, Wilkinson K, Roetker N, Schaefer J, Li A J Thromb Haemost. 2024; 22(12):3521-3531.

PMID: 39260742 PMC: 11608142. DOI: 10.1016/j.jtha.2024.08.016.

Universal EHRs Clinical Decision Support for Thromboprophylaxis in Medical Inpatients: A Cluster Randomized Trial.

Spyropoulos A, Goldin M, Koulas I, Solomon J, Qiu M, Ngu S JACC Adv. 2024; 2(8):100597.

PMID: 38938337 PMC: 11198051. DOI: 10.1016/j.jacadv.2023.100597.

System-Wide Thromboprophylaxis Interventions for Hospitalized Patients at Risk of Venous Thromboembolism: Focus on Cross-Platform Clinical Decision Support.

Tsaftaridis N, Goldin M, Spyropoulos A J Clin Med. 2024; 13(7).

PMID: 38610898 PMC: 11013003. DOI: 10.3390/jcm13072133.

Increasing venous thromboembolism risk assessment through a whole hospital-based intervention: a pre-post service evaluation to demonstrate quality improvement.

Abboud J, Shaikh N, Moosa M, Dempster M, Adair P Int J Qual Health Care. 2024; 36(1).

PMID: 38468470 PMC: 10928308. DOI: 10.1093/intqhc/mzae019.

Awareness and Knowledge of Venous Thromboembolism Among Saudi Adults in the Dawadmi Province: A Cross-Sectional Study.

Elmahdi E, Yousif B, Alotaibi M, Rashikh M, Alotaibi N, Alsaab S Cureus. 2024; 16(1):e52742.

PMID: 38384618 PMC: 10880873. DOI: 10.7759/cureus.52742.

References

Lau B, Haut E . Practices to prevent venous thromboembolism: a brief review. BMJ Qual Saf. 2013; 23(3):187-95. PMC: 3932749. DOI: 10.1136/bmjqs-2012-001782. View

Gould M, Garcia D, Wren S, Karanicolas P, Arcelus J, Heit J . Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e227S-e277S. PMC: 3278061. DOI: 10.1378/chest.11-2297. View

Kahn S, Panju A, Geerts W, Pineo G, Desjardins L, Turpie A . Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res. 2006; 119(2):145-55. DOI: 10.1016/j.thromres.2006.01.011. View

Shojania K, Duncan B, McDonald K, Wachter R, Markowitz A . Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 2001; (43):i-x, 1-668. PMC: 4781305. View

Dobromirski M, Cohen A . How I manage venous thromboembolism risk in hospitalized medical patients. Blood. 2012; 120(8):1562-9. DOI: 10.1182/blood-2012-03-378901. View

Shekelle P, Wachter R, Pronovost P, Schoelles K, McDonald K, Dy S . Making health care safer II: an updated critical analysis of the evidence for patient safety practices. Evid Rep Technol Assess (Full Rep). 2014; (211):1-945. PMC: 4781147. View

Garcia D, Highfill J, Finnerty K, Varoz E, McConkey S, Hutchinson K . A prospective, controlled trial of a pharmacy-driven alert system to increase thromboprophylaxis rates in medical inpatients. Blood Coagul Fibrinolysis. 2009; 20(7):541-5. DOI: 10.1097/MBC.0b013e32832d6cfc. View

Al-Hameed F, Al-Dorzi H, Aboelnazer E . The effect of a continuing medical education program on Venous thromboembolism prophylaxis utilization and mortality in a tertiary-care hospital. Thromb J. 2014; 12:9. PMC: 4041361. DOI: 10.1186/1477-9560-12-9. View

Adamali H, Suliman A, Zaid H, ODonoghue E, Burke A, Suliman A . A national house-staff audit of medical prophylaxis in medical patients for the PREVENTion of Venous ThromboEmbolism (PREVENT-VTE). Ir Med J. 2014; 106(10):302-5. View

10.

Hinchey J, Shephard T, Tonn S, Ruthazer R, Hermann R, Selker H . The Stroke Practice Improvement Network: a quasiexperimental trial of a multifaceted intervention to improve quality. J Stroke Cerebrovasc Dis. 2010; 19(2):130-7. PMC: 3307384. DOI: 10.1016/j.jstrokecerebrovasdis.2009.03.016. View

11.

Kahn S, Morrison D, Cohen J, Emed J, Tagalakis V, Roussin A . Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev. 2013; (7):CD008201. DOI: 10.1002/14651858.CD008201.pub2. View

12.

Stein P, Matta F, Dalen J . Is the campaign to prevent VTE in hospitalized patients working?. Chest. 2010; 139(6):1317-1321. DOI: 10.1378/chest.10-1622. View

13.

. Prevention and treatment of venous thromboembolism: international consensus statement (guidelines according to scientific evidence). Clin Appl Thromb Hemost. 2013; 19(2):116-8. DOI: 10.1177/1076029612474840. View

14.

Adams P, Riggio J, Thomson L, Brandell-Marino R, Merli G . Clinical decision support systems to improve utilization of thromboprophylaxis: a review of the literature and experience with implementation of a computerized physician order entry program. Hosp Pract (1995). 2012; 40(3):27-39. DOI: 10.3810/hp.2012.08.987. View

15.

Overhage J, Tierney W, McDonald C . Computer reminders to implement preventive care guidelines for hospitalized patients. Arch Intern Med. 1996; 156(14):1551-6. View

16.

Labarere J, Bosson J, Sevestre M, Sellier E, Richaud C, Legagneux A . Intervention targeted at nurses to improve venous thromboprophylaxis. Int J Qual Health Care. 2007; 19(5):301-8. DOI: 10.1093/intqhc/mzm034. View

17.

Kim P, Gasparis A, Probeck K, Elitharp D, Tassiopoulos A, Labropoulos N . Accuracy of venous thromboembolism assessment and compliance to prophylaxis in a tertiary care center. Phlebology. 2015; 31(8):541-5. DOI: 10.1177/0268355515604758. View

18.

Farfan M, Bautista M, Bonilla G, Rojas J, Llinas A, Navas J . Worldwide adherence to ACCP guidelines for thromboprophylaxis after major orthopedic surgery: A systematic review of the literature and meta-analysis. Thromb Res. 2016; 141:163-70. DOI: 10.1016/j.thromres.2016.03.029. View

19.

Kerbauy M, Moraes F, Kerbauy L, de Oliveira Conterno L, El-Fakhouri S . [Venous thromboprophylaxis in medical patients: an application review]. Rev Assoc Med Bras (1992). 2013; 59(3):258-64. DOI: 10.1016/j.ramb.2012.11.008. View

20.

Falck-Ytter Y, Francis C, Johanson N, Curley C, Dahl O, Schulman S . Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e278S-e325S. PMC: 3278063. DOI: 10.1378/chest.11-2404. View