Alerting Providers at Patient Hospital Discharge to Consider Prescribing Rivaroxaban to Reduce Venous Thromboembolism
eVTE (Electronic Venous Thromboembolism): A Cluster, Randomized, Step-wedge Type II Hybrid Study of an Alert Recommending Extended Duration Thromboprophylaxis for At-risk Discharging Medical Patients to Prevent VTE.
Scott C. Woller, MD
152,000 participants
Jun 1, 2024
INTERVENTIONAL
Conditions
Summary
A new algorithm derived from only patient age and components of the complete blood count and basic metabolic panel can identify patients discharged from the hospital who may benefit from a blood thinner (called rivaroxaban) to decrease their risk of blood clots, and for whom the risk of bleeding is minimal. The purpose of this study is to evaluate the use of a pop-up alert, which will be seen by clinicians when a discharging patient has been identified as being someone for whom the risk of blood clots is high, but for whom bleeding risk is estimated to be low. The pop-up alert will be enabled in a sequential fashion for each group of hospitals in 1 month blocks. We will look to see if the pop-up alert changes the number of patients who receive rivaroxaban. We will also measure the outcomes of blood clots and bleeding among all discharging patients.
Eligibility
Inclusion Criteria8
- Discharging clinician must be in one of the following iCentra electronic health record (Cerner, Kansas City, MO) positions:
- Physician, nurse practitioner, or physician assistant hospitalist
- Physician internal medicine
- Physician family medicine
- Patient age ≥ 18 years.
- The encounter must be inpatient.
- A signed hospital discharge order must be present.
- eVTE target population criteria (increased venous thromboembolism risk, low bleeding risk) must be met
Exclusion Criteria15
- Pregnant during encounter
- Discharge order completed by ineligible clinician type
- Exclude all cases where the patient is being actively prescribed and intended to be discharged on the following qualifying anticoagulant medications, regardless of dose form or dosing regimen (i.e., they have an active prescription for one of these medications):
- Apixaban
- Dabigatran
- Dalteparin
- Enoxaparin
- Edoxaban
- Betrixaban
- Fondaparinux
- Rivaroxaban
- Warfarin
- Creatinine clearance \<30 milliliters/minute based on last-available eligible serum creatinine value preceding discharge
- Estimated creatine clearance based on actual body weight (preferred) ((140 - age years) \* measured weight kilograms) / (72.0 \* serum creatine milligrams/deciliter) (\*0.85 if female)) = milliliters/minute
- If measured body weight not available, then based on ideal body weight ((140 - age years) \* ideal body weight kilograms) / (72.0 \* serum creatine milligrams/deciliter) (\*0.85 if female)) = milliliters/minute
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Interventions
Pop-up alert that informs the discharging clinician that the patient meets criteria to be considered for extended duration thromboprophylaxis
During the baseline phase while risk is assessed and stored, no alerting occurs
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT06232551