SHM Converge Scientific Abstract ePoster Gallery-Clinical Decision Support Tools Enhance Thromboprophylaxis in Older Covid-19 Patients

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This post-hoc subgroup analysis examined whether an electronic health record–agnostic clinical decision support (CDS) tool using the IMPROVE-DD venous thromboembolism (VTE) risk score could improve thromboprophylaxis and outcomes in older hospitalized COVID-19 patients.<br /><br />The study included 2,452 patients aged 60 years or older who were immobile for at least one day and at intermediate or high thrombotic risk. The intervention group had 1,355 patients and the control group 1,097. Baseline characteristics were generally similar.<br /><br />The CDS tool had very high adoption (96.8%). It did not significantly improve appropriate inpatient thromboprophylaxis, which was already high in both groups (87.2% vs 84.9%). However, it significantly increased appropriate post-discharge extended thromboprophylaxis among high-risk patients, with use rising from 28.8% in controls to 42.6% in the intervention group.<br /><br />Clinical outcomes favored the intervention. Compared with control, the intervention group had lower rates of:<br />- VTE: 4.8% vs 8.6%<br />- ATE: 0.1% vs 0.7%<br />- Total thromboembolism: 4.9% vs 9.3%<br /><br />There was no significant increase in major bleeding, suggesting improved prevention without added bleeding harm. All-cause mortality was similar between groups, but all-cause readmission/death was modestly reduced in the intervention group.<br /><br />Overall, the findings suggest that a portable, EHR-independent CDS tool using IMPROVE-DD can improve discharge thromboprophylaxis and reduce thromboembolic events in older COVID-19 inpatients, especially by supporting extended post-discharge prophylaxis.

Asset Subtitle

Nikolaos Tsaftaridis

Meta Tag

Author List Alex C. Spyropoulos, Ioannis Koulas, Jeffrey Solomon, Kanta Ochani, Kolton Smith, Mark Goldin, Michael Qiu, Nikolaos Tsaftaridis, Tung Ming Leung

Category Research

Concept Clinical Decision Support

Concept Extended Thromboprophylaxis

Concept IMPROVE-DD

Concept Thromboembolism Risk Assessment

Concept Post-discharge Prophylaxis

Distinguished Non-Finalist

Presenter Organization Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA

Presenter Organization Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA

Presenting Author Nikolaos Tsaftaridis

Track Technology in Hospital Medicine

Keywords

COVID-19

venous thromboembolism

thromboprophylaxis

clinical decision support

IMPROVE-DD

hospitalized patients

extended prophylaxis

older adults

thromboembolism

electronic health record

Clinical Decision Support

Extended Thromboprophylaxis

IMPROVE-DD

Thromboembolism Risk Assessment

Post-discharge Prophylaxis