Abstract 8642: A Randomized Controlled Trial of Physician Alerts to Prevent Symptomatic Venous Thromboembolism after Hospital Discharge

Abstract

Introduction: Many patients develop venous thromboembolism (VTE) in the months following hospitalization for medical illness. Hypothesis: We assessed the hypothesis that a VTE prophylaxis alert from a hospital staff member to the Attending Physician prior to patient discharge from the hospital will reduce the incidence of symptomatic VTE after discharge. Methods: We enrolled hospitalized Medical Service patients in a large multicenter randomized controlled trial using a validated point score system to identify those at high risk for symptomatic VTE who were not ordered to receive VTE prophylaxis after discharge. Results: Among 2,513 eligible patients randomized from 18 study sites, 1,252 were assigned to the intervention group, and 1,261 were assigned to the control group. Patients in the intervention group were more than twice as likely to receive VTE prophylaxis at discharge as controls (22.0% versus 9.7%, p<0.0001). Symptomatic VTE at 90 days (99.9% follow-up) occurred in 4.5% of patients in the intervention group compared with 4.0% of controls (hazard ratio, 1.12; 95% confidence interval, 0.74 to 1.69). Rates of death at 90 days and major bleeding at 30 days in the intervention group were similar to that of the control group. In an on-treatment analysis, we observed a nearly one-third reduction in 90-day mortality among at-risk medical patients whose physicians were alerted and in whom discharge prophylaxis was prescribed compared with those in whom the alert recommendation was not followed and compared with those for whom an alert was not issued and prophylaxis was not ordered after hospital discharge. Conclusion: We observed no difference in the rate of symptomatic VTE in patients assigned to the alert group compared with controls. The physician alert doubled the rate of VTE prophylaxis ordered at the time of hospital discharge. Further Quality Improvement initiatives to improve VTE prevention after hospital discharge are warranted.