An Electronic Alert System Is Associated With a Significant Increase in Pharmacologic Venous Thromboembolism Prophylaxis Rates Among Hospitalized Inflammatory Bowel Disease Patients

Mathers, Bradley; Williams, Emmanuelle; Bedi, Gurneet; Tinsley, Andrew

doi:10.1097/jhq.0000000000000021

Cited by 11 publications

(11 citation statements)

References 21 publications

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“…Other studies showed variable rates of VTE prophylaxis use in their institutes. These rates are still suboptimal, ranging from 25-80% of IBD patients admitted for various reasons [15,20,21].…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism prophylaxis in inflammatory bowel disease flare-ups

Kaddourah¹,

Numan

Jeepalyam

et al. 2019

aog

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Background:Inflammatory bowel disease (IBD) is a set of chronic inflammatory diseases associated with significant morbidity. Generally, IBD patients have twice the risk of venous thromboembolism (VTE) compared to healthy controls. VTE in IBD is associated with greater morbidity and mortality. This is compounded by the underutilization of pharmacological anticoagulation in hospitalized patients with IBD. One study showed that half the IBD patients who developed VTE were not receiving any thrombotic prophylaxis.Method:We carried out a retrospective chart review of VTE prophylaxis use and safety in patients admitted with IBD flare-up between 2014 and 2017.Results:We evaluated 233 patients (mean age 36.7 years; 53.6% male). Of these patients, 55.2% were Caucasian and 40.5% were African American; 72.5% had Crohn’s disease and 21% ulcerative colitis. About one-third of our patients were on chronic steroids. Pharmacological prophylaxis was used in 39.7% of the patients. This significantly correlated with male sex, recent surgery, history of VTE, smoking, and chronic steroid use. Meanwhile, hematochezia, aspirin use, and a history of gastrointestinal bleeding were correlated with less use of pharmacological prophylaxis. Patients receiving pharmacological prophylaxis showed no difference in the incidence of bleeding events.Conclusions:Multiple factors were associated with the use of pharmacological prophylaxis in hospitalized patients, including sex, steroid use, history of VTE events or gastrointestinal bleeding, and hematochezia. The incidence of major bleeding was not significantly greater in IBD patients receiving pharmacological prophylaxis.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism prophylaxis in inflammatory bowel disease flare-ups

Kaddourah¹,

Numan

Jeepalyam

et al. 2019

aog

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“…Since the introduction of the ACCP guidelines and the inclusion of the new measures quality-based reimbursements by the Centers for Medicare & Medicaid Services, there has been a rise in the rate of VTE prophylaxis. 5 , 6 , 7 However, the quality measure is based on the presence or absence of documentation and not on the appropriateness of VTE prophylaxis. Previous studies including the Prophylaxis in Medical Patients with Enoxaparin (MEDENOX) study (N=1102) 10 and the Arixtra for Thromboembolism Prevention in a Medical Indications Study (ARTEMIS) (N=849) 11 have shown a significant reduction in the incidence of VTE events with prophylactic use of enoxaparin (risk ratio, 0.37; 95% CI, 0.22-0.63; P <.001) and fondaparinux (relative risk reduction, 46.7%; 95% CI, 7.7%-69.3%; P =.02), respectively, in medically ill hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, previous studies evaluating the utility of clinical decision support tools have shown mixed results. 6 , 15 , 18 , 19 , 20 Of note, the studies that showed a significant improvement in appropriate risk stratification with the introduction of clinical decision tools had an additional component of an extensive educational program 6 , 18 , 19 compared with those that did not. 15 , 20 Thus, we recommend that clinical decision tools be accompanied by extensive educational programs to reduce the inappropriate stratification and institution of VTE prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…5 Following the introduction of quality-based reimbursement, an increasing rate of compliance with VTE prophylaxis (from 10% to 60%) has been observed. 6 , 7 We hypothesized that in low-risk patients with VTE, chemoprophylaxis is prescribed more often than mechanical prophylaxis. In this study, we examined the extent and appropriate use (type and dosage) of VTE prophylaxis in hospitalized medically ill patients in a large teaching hospital in Baltimore, Maryland.…”

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confidence: 99%

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Venous Thromboembolism Prophylaxis: Inadequate and Overprophylaxis When Comparing Perceived Versus Calculated Risk

Chaudhary

Damluji

Batukbhai

et al. 2017

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Guidelines for venous thromboembolism (VTE) prophylaxis recommend appropriate risk stratification using risk estimation models as high risk or low risk followed by initiation of chemical or mechanical prophylaxis, respectively. We explored adherence to guidelines on the basis of the documentation of VTE prophylaxis. A retrospective medical record review of 437 consecutive adult patients (≥18 years) admitted to general medical wards under medicine service between January 1, 2015, and March 1, 2015, was performed. The primary outcome was appropriateness of risk stratification using the Padua Prediction Score. Secondary outcomes were appropriateness of type of prophylaxis (chemical vs mechanical) and cost-benefit analysis. We observed appropriate stratification based on the documented risk (compared with the calculated risk) in 54.9% of the patients (40.8% with low risk vs 72.1% with high risk; P<.001). Overall, 182 of 240 low-risk patients received unnecessary chemical prophylaxis, whereas 23 of 197 high-risk patients without contraindications for chemical prophylaxis received mechanical or no prophylaxis. No clinical VTE events were noted in the patients inappropriately assigned to mechanical or no prophylaxis. Also, 67.3% of patients with both low documented and low calculated risk and 74.5% of patients with low documented and high calculated risk received chemical prophylaxis, consistent with a tendency toward overtreatment. A total of 4068 annualized patient-days ($77,652/y) of inappropriate chemical prophylaxis were administered. In conclusion, estimation of the risk of VTE based on clinical impression was not congruent with the risk calculated using risk prediction models and was associated with a tendency toward overtreatment. These data support the inclusion of VTE risk calculators in electronic health record systems.

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“…Implementation of an electronic alert system seems to be an effective tool for increasing VTE prophylaxis rates in hospitalized patients with IBD. The introduction of this system was associated with a significant improvement in prophylaxis rates in both medical (26.3% vs 62.8%) and surgical (83.7% vs 95.5%) services[ 101 ]. All providers should be educated on the increased risk of VTE as well as the safety of pharmacologic prophylaxis.…”

Section: Prophylaxis Of Vte In Ibdmentioning

confidence: 99%

Venous and arterial thromboembolism in patients with inflammatory bowel diseases

Stadnicki¹,

Stadnicka²

2021

WJG

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The risk of thromboembolism (TE) is increased in patients with inflammatory bowel disease (IBD), mainly due to an increased risk of venous TE (VTE). The risk of arterial TE (ATE) is less pronounced, but an increased risk of cardiovascular diseases needs to be addressed in IBD patients. IBD predisposes to arterial and venous thrombosis through similar prothrombotic mechanisms, including triggering activation of coagulation, in part mediated by impairment of the intestinal barrier and released bacterial components. VTE in IBD has clinical specificities, i.e. , an earlier first episode in life, high rates during both active and remission stages, higher recurrence rates, and poor prognosis. The increased likelihood of VTE in IBD patients may be related to surgery, the use of medications such as corticosteroids or tofacitinib, whereas infliximab is antithrombotic. Long-term complications of VTE can include post-thrombotic syndrome and high recurrence rate during post-hospital discharge. A global clot lysis assay may be useful in identifying patients with IBD who are at risk for TE. Many VTEs occur in IBD outpatients; therefore, outpatient prophylaxis in high-risk patients is recommended. It is crucial to continue focusing on prevention and adequate treatment of VTE in patients with IBD.

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An Electronic Alert System Is Associated With a Significant Increase in Pharmacologic Venous Thromboembolism Prophylaxis Rates Among Hospitalized Inflammatory Bowel Disease Patients

Abstract: The introduction of an electronic alert system was associated with a significant increase in rates of pharmacologic VTE prophylaxis. However, orders were often delayed and doses not always administered. The most common reason that ordered doses were not given was patient refusal.

Cited by 11 publications

References 21 publications

Venous thromboembolism prophylaxis in inflammatory bowel disease flare-ups

Venous thromboembolism prophylaxis in inflammatory bowel disease flare-ups

Venous Thromboembolism Prophylaxis: Inadequate and Overprophylaxis When Comparing Perceived Versus Calculated Risk

Venous and arterial thromboembolism in patients with inflammatory bowel diseases

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