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Universal clinical decision support tool for thromboprophylaxis in hospitalized COVID-19 patients: post hoc analysis
Mark Goldin1, Nikolaos Tsaftaridis2, Ioannis Koulas3
1Northwell, New Hyde Park, New York, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
Insights
A novel clinical decision support tool improved thromboprophylaxis in COVID-19 patients, reducing venous thromboembolism and readmissions without increasing bleeding risk.
Area of Science:
- Medical Informatics
- Cardiology
- Infectious Diseases
Background:
- Suboptimal thromboprophylaxis in COVID-19 patients despite guidelines.
- Need for improved strategies for inpatient and extended postdischarge care.
Purpose of the Study:
- Evaluate a novel electronic health record-agnostic clinical decision support (CDS) tool.
- Assess if the tool, using IMPROVE-DD VTE scores, increases appropriate thromboprophylaxis and improves outcomes in COVID-19 inpatients.
Main Methods:
- Post hoc analysis of a cluster randomized trial.
- COVID-19 inpatients at 4 hospitals, randomized to CDS vs. usual care.
- Primary outcome: appropriate thromboprophylaxis rate; Secondary: thromboembolism, bleeding, readmissions, mortality.
Main Results:
- High CDS adoption (96.8%).
- Increased appropriate extended thromboprophylaxis (42.6% vs. 28.8%).
- Reduced VTE, arterial thromboembolism, total thromboembolism, and 30-day all-cause readmission/death.
Conclusions:
- EHR-agnostic CDS tool effectively increased appropriate thromboprophylaxis.
- The tool reduced thromboembolic events and readmissions in COVID-19 patients.
- No increase in major bleeding observed.
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.
