Effectiveness of interventions for the implementation of thromboprophylaxis in hospitalised patients at risk of venous thromboembolism: an updated abridged Cochrane systematic review and meta-analysis of randomised controlled trials

Abstract

ObjectiveTo assess the effectiveness of system-wide interventions designed to increase the implementation of thromboprophylaxis and decrease the incidence of venous thromboembolism (VTE) in hospitalised medical and surgical patients at risk of VTE.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).Data sourcesMedline, PubMed, Embase, BIOSIS, CINAHL, Web of Science, CENTRAL, DARE, EED, LILACS and clinicaltrials.gov without language restrictions from inception to 7 January 2017, as well as the reference lists of relevant review articles.Eligibility criteria for selecting studiesRCTs that evaluated the effectiveness of system-wide interventions such as alerts, multifaceted, education, and preprinted orders when compared with no intervention, existing policy or another intervention.ResultsWe included 13 RCTs involving 35 997 participants. Eleven RCTs had data available for meta-analysis. Compared with control, we found absolute increase in the prescription of prophylaxis associated with alerts (21% increase, 95% CI [15% to 275%]) and multifaceted interventions (4% increase, 95% CI [3% to 11%]), absolute increase in the prescription of appropriate prophylaxis associated with alerts (16% increase, 95% CI [12% to 20%]) and relative risk reductions (risk ratio 64%, 95% CI [47% to 86%]) in the incidence of symptomatic VTE associated with alerts. Computer alerts were found to be more effective than human alerts, and multifaceted interventions with an alert component appeared to be more effective than multifaceted interventions without, although comparative pooled analyses were not feasible. The quality of evidence for improvement in outcomes was judged to be low to moderate certainty.ConclusionsAlerts increased the proportion of patients who received prophylaxis and appropriate prophylaxis, and decreased the incidence of symptomatic VTE. Multifaceted interventions increased the proportion of patients who received prophylaxis but were found to be less effective than alerts interventions.Trial registration numberCD008201.

Awareness, knowledge, and attitude toward venous thromboembolism among Aseer Population, Saudi Arabia

“…Thrombosis is a major cause of morbidity and mortality worldwide and significantly funds the economic disease burden. [ 9 ] Thrombophylaxis in hospitalized patients markedly decreased the incidence of VTE in that group of patients but, however, lack of public awareness and knowledge of use of thrombophylaxis in at-risk, no hospitalized patients, still contribute to high morbidity and mortality[ 10 ] with multiple calls to enhance public awareness of VTE. [ 11 ] This study provides an overview of awareness and knowledge toward VTE in Aseer region, KSA.…”

Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review

“…3 4 Consequently, there has been a substantial and sustained focus on VTE prevention over the last three decades, with good evidence indicating a reduction in morbidity with primary thromboprophylaxis in hospitalised patients. [5][6][7][8] Despite this evidence, thromboprophylaxis remains either underused or inappropriately applied. 9 Risk assessment models (RAMs) have been developed to help stratify the risk of VTE among hospitalised patients.…”

A qualitative study of physicians’ perceptions and preferences for implementing Venous Thromboembolism (VTE) clinical practice guidelines informed by the Theoretical Domains Framework (TDF)

“…It was also reported that most of the interventions followed in these studies were effective at increasing the appropriate prophylaxis, however, the effectiveness level was different between studies (11). Moreover, it was revealed in the updated systematic review, including RCT studies, that alerts interventions involving computer and human alerts are more effective than multifaceted interventions in increasing the appropriate prophylaxis prescriptions and decreasing the incidence of VTE in at risk hospitalized medical and surgical patients (12). Furthermore, studies derived from behaviour change theory to inform the intervention to increase the uptake of VTE guidelines in medical patients were not identi ed in our systematic review study (13).…”