Universal clinical decision support tool for thromboprophylaxis in hospitalized COVID-19 patients: post hoc analysis of the IMPROVE-DD cluster randomized trial.

Autor:	Goldin M; Northwell, 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. Electronic address: mgoldin@northwell.edu., Tsaftaridis N; Northwell, New Hyde Park, New York, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA., Koulas I; Northwell, New Hyde Park, New York, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA; Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA., Solomon J; Northwell, New Hyde Park, New York, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA., Qiu M; Northwell, New Hyde Park, New York, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA., Leung T; Northwell, New Hyde Park, New York, USA; Biostatistics Unit, Office of Academic Affairs, Northwell, Hempstead, New York, USA., Smith K; Northwell, New Hyde Park, New York, USA; Department of Internal Medicine, Lenox Hill Hospital at Northwell Health, New York, New York, USA., Ochani K; Northwell, New Hyde Park, New York, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA., McGinn T; Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; CommonSpirit Health, Chicago, Illinois, USA., Spyropoulos AC; Northwell, 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. Electronic address: https://twitter.com/AlexSpyropoul.
Jazyk:	angličtina
Zdroj:	Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2024 Nov; Vol. 22 (11), pp. 3172-3182. Date of Electronic Publication: 2024 Aug 14.
DOI:	10.1016/j.jtha.2024.07.025
Abstrakt:	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. Competing Interests: Declaration of competing interests A.C.S. reports honoraria from Janssen, Bayer, Bristol Myers Squibb, Pfizer, and Sanofi and research grants from Janssen and Boehringer Ingelheim. He is also a member of the Antithrombotic Trials Leadership and Steering (ATLAS) group, an academic research organization. M.G. reports grant support from Janssen and AstraZeneca. The other authors report no conflicts. (Copyright © 2024 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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