Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients.
Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients.
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DOI：
10.1161/circulationaha.108.841197
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发表时间：
2009-04-28
期刊：
影响因子：
37.8
通讯作者：
Goldhaber SZ
中科院分区：
文献类型：
--
作者：
Piazza G;Rosenbaum EJ;Pendergast W;Jacobson JO;Pendleton RC;McLaren GD;Elliott CG;Stevens SM;Patton WF;Dabbagh O;Paterno MD;Catapane E;Li Z;Goldhaber SZ
Venous thromboembolism (VTE) prophylaxis remains underutilized among hospitalized patients. We designed and carried out a large multicenter randomized controlled trial to test the hypothesis that an alert from a hospital staff member to the Attending Physician will reduce the rate of symptomatic VTE among high-risk patients not receiving prophylaxis. We enrolled patients using a validated point score system to detect hospitalized patients at high risk for symptomatic VTE who were not receiving prophylaxis. 2,493 patients (82% on Medical Services) from 25 study sites were randomized to the intervention group (n=1,238), in which the responsible physician was alerted by another hospital staff member, versus the control group (n=1,255), in which no alert was issued. The primary end point was symptomatic, objectively confirmed VTE within 90 days. Patients whose physicians were alerted were more than twice as likely to receive VTE prophylaxis as controls (46.0% versus 20.6%, p<0.0001). The symptomatic VTE rate was lower in the intervention group (2.7% versus 3.4%; hazard ratio, 0.79; 95% confidence interval, 0.50 to 1.25), but the difference did not achieve statistical significance. The rate of major bleeding at 30 days in the alert group was similar to the control group (2.1% versus 2.3%, p=0.68). A strategy of direct staff member to physician notification increases prophylaxis utilization and leads toward reducing the rate of symptomatic VTE in hospitalized patients. However, VTE prophylaxis continues to be underutilized even after physician notification, especially among Medical Service patients.
