SHM Converge Scientific Abstract ePoster Gallery-Barriers to the Use of Rivaroxaban for Inpatient Venous Thromboembolism Chemoprophylaxis: A Quality Improvement Study

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This quality improvement study examined barriers to using rivaroxaban, an oral direct oral anticoagulant (DOAC), for venous thromboembolism (VTE) chemoprophylaxis in hospitalized general medicine patients. While heparin and low-molecular-weight heparin are the usual injectable options, rivaroxaban was added to the inpatient order set on April 8, 2021 as an alternative for appropriately selected patients.<br /><br />The study reviewed use on a single inpatient medicine unit and surveyed hospitalists and residents about their experience. Among 46 clinicians surveyed, less than half had ever ordered rivaroxaban for VTE prophylaxis. The most common barriers were concern that rivaroxaban would complicate periprocedural management or delay procedures, unfamiliarity with how to order it, uncertainty about contraindications, and preference for familiar injectable agents.<br /><br />In response, the team updated the VTE prophylaxis order set to clarify contraindications, created an educational guide summarizing major rivaroxaban trials, and began discussions with procedural specialists to standardize anticoagulation guidance for minor procedures.<br /><br />Patient data showed that rivaroxaban was used in a small subset of hospitalized patients, with baseline characteristics including older age, obesity, prior VTE history, and varied admission diagnoses. Overall, the project suggests that DOACs can be used successfully for inpatient VTE prophylaxis, but provider hesitancy remains common. The main obstacle is not lack of feasibility, but concern about procedure-related interruptions and limited clinician familiarity. Future work should evaluate safety, efficacy, patient adherence, preferences, and whether the interventions increased prescribing over time.

Asset Subtitle

Joseph F. Mort

Meta Tag

Author List Hillary Maitland, Jennifer Walters, Joseph F. Mort

Category Research

Concept Venous Thromboembolism

Concept Chemoprophylaxis

Concept Rivaroxaban

Concept Direct Oral Anticoagulant

Concept Hospitalized Patients

Distinguished Non-Finalist

Presenter Organization University of Virginia Health System

Presenting Author Joseph F. Mort

Track Quality Improvement

Keywords

rivaroxaban

venous thromboembolism

VTE prophylaxis

hospitalized patients

direct oral anticoagulant

quality improvement

order set

provider barriers

procedural management

inpatient medicine

Venous Thromboembolism

Chemoprophylaxis

Rivaroxaban

Direct Oral Anticoagulant

Hospitalized Patients