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CCDSSs to prevent VTE
Title: Use of computerized clinical decision support systems decreases venous thromboembolic events in surgical patients
Clinical Question: Do computerized clinical decision support systems (CCDSSs) decrease the risk of venous thromboembolism (VTE) in surgical patients?
Background: VTE remains the leading preventable cause of death in the hospital. Despite multiple tools that are available to stratify risk of VTE, they are not used uniformly or are used incorrectly. It is unclear whether CCDSSs help prevent VTE compared to standard care.
Study Design: Retrospective systematic review and meta-analysis.
Setting: 188 studies initially screened, 11 studies were included.
Synopsis: Multiple studies relevant to the topic were reviewed; only studies that used an electronic medical record (EMR)–based tool to augment the rate of appropriate prophylaxis of VTE were included. Primary outcomes assessed were rate of appropriate prophylaxis for VTE and rate of VTE events. A total of 156,366 patients were analyzed, of which 104,241 (66%) received intervention with CCDSSs and 52,125 (33%) received standard care (physician judgment and discretion). The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% confidence interval, 1.78-3.10; P less than .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P less than .001). The major limitation of this study is that it did not evaluate the number of adverse events as a result of VTE prophylaxis, such as bleeding, which may have been significantly increased in the CCDSS group.
Bottom Line: The use of CCDSSs increases the proportion of surgical patients who are prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.
Citation: Borab ZM, Lanni MA, Tecce MG, Pannucci CJ, Fischer JP. Use of computerized clinical decision support systems to prevent venous thromboembolism in surgical patients: A systematic review and meta-analysis. JAMA Surg. 2017; doi: 10.1001/jamasurg.2017.0131.
Dr. Mayasy is assistant professor in the department of hospital medicine at the University of New Mexico.
Title: Use of computerized clinical decision support systems decreases venous thromboembolic events in surgical patients
Clinical Question: Do computerized clinical decision support systems (CCDSSs) decrease the risk of venous thromboembolism (VTE) in surgical patients?
Background: VTE remains the leading preventable cause of death in the hospital. Despite multiple tools that are available to stratify risk of VTE, they are not used uniformly or are used incorrectly. It is unclear whether CCDSSs help prevent VTE compared to standard care.
Study Design: Retrospective systematic review and meta-analysis.
Setting: 188 studies initially screened, 11 studies were included.
Synopsis: Multiple studies relevant to the topic were reviewed; only studies that used an electronic medical record (EMR)–based tool to augment the rate of appropriate prophylaxis of VTE were included. Primary outcomes assessed were rate of appropriate prophylaxis for VTE and rate of VTE events. A total of 156,366 patients were analyzed, of which 104,241 (66%) received intervention with CCDSSs and 52,125 (33%) received standard care (physician judgment and discretion). The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% confidence interval, 1.78-3.10; P less than .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P less than .001). The major limitation of this study is that it did not evaluate the number of adverse events as a result of VTE prophylaxis, such as bleeding, which may have been significantly increased in the CCDSS group.
Bottom Line: The use of CCDSSs increases the proportion of surgical patients who are prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.
Citation: Borab ZM, Lanni MA, Tecce MG, Pannucci CJ, Fischer JP. Use of computerized clinical decision support systems to prevent venous thromboembolism in surgical patients: A systematic review and meta-analysis. JAMA Surg. 2017; doi: 10.1001/jamasurg.2017.0131.
Dr. Mayasy is assistant professor in the department of hospital medicine at the University of New Mexico.
Title: Use of computerized clinical decision support systems decreases venous thromboembolic events in surgical patients
Clinical Question: Do computerized clinical decision support systems (CCDSSs) decrease the risk of venous thromboembolism (VTE) in surgical patients?
Background: VTE remains the leading preventable cause of death in the hospital. Despite multiple tools that are available to stratify risk of VTE, they are not used uniformly or are used incorrectly. It is unclear whether CCDSSs help prevent VTE compared to standard care.
Study Design: Retrospective systematic review and meta-analysis.
Setting: 188 studies initially screened, 11 studies were included.
Synopsis: Multiple studies relevant to the topic were reviewed; only studies that used an electronic medical record (EMR)–based tool to augment the rate of appropriate prophylaxis of VTE were included. Primary outcomes assessed were rate of appropriate prophylaxis for VTE and rate of VTE events. A total of 156,366 patients were analyzed, of which 104,241 (66%) received intervention with CCDSSs and 52,125 (33%) received standard care (physician judgment and discretion). The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% confidence interval, 1.78-3.10; P less than .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P less than .001). The major limitation of this study is that it did not evaluate the number of adverse events as a result of VTE prophylaxis, such as bleeding, which may have been significantly increased in the CCDSS group.
Bottom Line: The use of CCDSSs increases the proportion of surgical patients who are prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.
Citation: Borab ZM, Lanni MA, Tecce MG, Pannucci CJ, Fischer JP. Use of computerized clinical decision support systems to prevent venous thromboembolism in surgical patients: A systematic review and meta-analysis. JAMA Surg. 2017; doi: 10.1001/jamasurg.2017.0131.
Dr. Mayasy is assistant professor in the department of hospital medicine at the University of New Mexico.
Rivaroxaban or aspirin for extended treatment of VTE
TITLE: Low-dose or full-dose rivaroxaban is superior to aspirin for long-term anticoagulation
CLINICAL QUESTION: Is full or lower intensity rivaroxaban better for extended treatment of venous thromboembolism (VTE) as compared to aspirin?
STUDY DESIGN: Multicenter randomized double-blinded phase III trial.
SETTING: 230 Medical centers worldwide in 20 countries.
SYNOPSIS: 3,365 patients with a history of VTE who had undergone 6-12 months of initial anticoagulation therapy and in whom continuation of therapy was thought to be beneficial were enrolled. Patients were randomly assigned to daily high-dose rivaroxaban (20 mg) or daily low-dose rivaroxaban (10 mg) or aspirin (100 mg). After a median of 351 days, symptomatic recurrent VTE or unexplained death occurred in 17 of the 1,107 patients (1.5%) who were assigned to the high-dose group, in 13 of 1,127 patients (1.2%) who were assigned to the low-dose group, and in 50 of 1,131 patients (4.4%) who were assigned to aspirin. Bleeding rates were not significantly different between the three groups (2%-3%). The major limitation of this study is the short duration of follow-up and the lack of power to demonstrate noninferiority of the low-dose as compared to the high-dose regimen for rivaroxaban.
BOTTOM LINE: In patients with a history of VTE, in whom prolonged anticoagulation could be beneficial, low or high-dose rivaroxaban is superior to aspirin in preventing recurrent VTE without increasing bleeding risk.
CITATION: Weitz JI, Lensing MH, Prins R, et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017; 376:1211-22.
Dr. Mayasy is assistant professor in the department of hospital medicine at the University of New Mexico.
TITLE: Low-dose or full-dose rivaroxaban is superior to aspirin for long-term anticoagulation
CLINICAL QUESTION: Is full or lower intensity rivaroxaban better for extended treatment of venous thromboembolism (VTE) as compared to aspirin?
STUDY DESIGN: Multicenter randomized double-blinded phase III trial.
SETTING: 230 Medical centers worldwide in 20 countries.
SYNOPSIS: 3,365 patients with a history of VTE who had undergone 6-12 months of initial anticoagulation therapy and in whom continuation of therapy was thought to be beneficial were enrolled. Patients were randomly assigned to daily high-dose rivaroxaban (20 mg) or daily low-dose rivaroxaban (10 mg) or aspirin (100 mg). After a median of 351 days, symptomatic recurrent VTE or unexplained death occurred in 17 of the 1,107 patients (1.5%) who were assigned to the high-dose group, in 13 of 1,127 patients (1.2%) who were assigned to the low-dose group, and in 50 of 1,131 patients (4.4%) who were assigned to aspirin. Bleeding rates were not significantly different between the three groups (2%-3%). The major limitation of this study is the short duration of follow-up and the lack of power to demonstrate noninferiority of the low-dose as compared to the high-dose regimen for rivaroxaban.
BOTTOM LINE: In patients with a history of VTE, in whom prolonged anticoagulation could be beneficial, low or high-dose rivaroxaban is superior to aspirin in preventing recurrent VTE without increasing bleeding risk.
CITATION: Weitz JI, Lensing MH, Prins R, et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017; 376:1211-22.
Dr. Mayasy is assistant professor in the department of hospital medicine at the University of New Mexico.
TITLE: Low-dose or full-dose rivaroxaban is superior to aspirin for long-term anticoagulation
CLINICAL QUESTION: Is full or lower intensity rivaroxaban better for extended treatment of venous thromboembolism (VTE) as compared to aspirin?
STUDY DESIGN: Multicenter randomized double-blinded phase III trial.
SETTING: 230 Medical centers worldwide in 20 countries.
SYNOPSIS: 3,365 patients with a history of VTE who had undergone 6-12 months of initial anticoagulation therapy and in whom continuation of therapy was thought to be beneficial were enrolled. Patients were randomly assigned to daily high-dose rivaroxaban (20 mg) or daily low-dose rivaroxaban (10 mg) or aspirin (100 mg). After a median of 351 days, symptomatic recurrent VTE or unexplained death occurred in 17 of the 1,107 patients (1.5%) who were assigned to the high-dose group, in 13 of 1,127 patients (1.2%) who were assigned to the low-dose group, and in 50 of 1,131 patients (4.4%) who were assigned to aspirin. Bleeding rates were not significantly different between the three groups (2%-3%). The major limitation of this study is the short duration of follow-up and the lack of power to demonstrate noninferiority of the low-dose as compared to the high-dose regimen for rivaroxaban.
BOTTOM LINE: In patients with a history of VTE, in whom prolonged anticoagulation could be beneficial, low or high-dose rivaroxaban is superior to aspirin in preventing recurrent VTE without increasing bleeding risk.
CITATION: Weitz JI, Lensing MH, Prins R, et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017; 376:1211-22.
Dr. Mayasy is assistant professor in the department of hospital medicine at the University of New Mexico.