Related Experiment Video

Updated: Jan 8, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

84.3K

Effect of Clinical Decision Support Alerts on Anticoagulation Management in Atrial Fibrillation

Joseph E Capito1, Brian Z Dilcher2, Zulkifl I Jafary3

  • 1Department of Family Medicine, West Virginia University, Morgantown, West Virginia, United States.

Applied Clinical Informatics
|December 18, 2025
PubMed

Insights

Electronic health record alerts for atrial fibrillation (AF) anticoagulation management improved provider engagement. Real-time risk score integration supported clinical decisions, particularly for initiating anticoagulation in high-risk patients.

Area of Science:

  • Internal Medicine
  • Cardiology
  • Health Informatics

Background:

  • Anticoagulation decisions in atrial fibrillation (AF) require balancing stroke and bleeding risks using CHA₂DS₂-VASc and HAS-BLED scores.
  • Manual calculation of these risk scores is time-consuming and prone to inconsistency.
  • Electronic Health Record (EHR) integration offers a potential solution for streamlining risk assessment.

Purpose of the Study:

  • To evaluate the impact of real-time, EHR-integrated alerts on provider behavior in anticoagulation management for AF patients.
  • To assess physician and non-physician provider (NPP) interaction with an EHR-based advisory tool.

Main Methods:

  • A single-arm observational study was conducted at a rural academic primary care clinic.
  • An EHR rules-based engine calculated CHA₂DS₂-VASc and HAS-BLED scores and displayed them via non-interruptive alerts.
  • Provider interactions (initiation of anticoagulation, documented rationale, exclusion diagnosis) were analyzed using chi-square testing.

Main Results:

  • Among 313 patients triggering alerts, 16.9% were newly anticoagulated, and 35.8% had a documented rationale for not initiating therapy.
  • 50.5% of patients experienced a clinically meaningful interaction with the alert tool (χ² = 9.82, p = 0.0017).
  • The overall alert success rate across 2,447 encounters was 19.8%, indicating significant point-of-care engagement.

Conclusions:

  • Real-time EHR alerts displaying stroke and bleeding risk scores are associated with meaningful provider engagement in AF anticoagulation management.
  • The tool demonstrated potential in supporting point-of-care decision-making, particularly for initiating anticoagulation in high-risk individuals.
  • Further investigation of EHR-based advisories is warranted to enhance anticoagulation management in AF.

More Related Videos

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.9K
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood11:17

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

Published on: October 12, 2012

14.3K

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
262
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.0K
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.6K
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
293
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
182
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
197