Universal clinical decision support tool for thromboprophylaxis in hospitalized COVID-19 patients: post hoc analysis of the IMPROVE-DD cluster randomized trial.

Goldin M, Tsaftaridis N, Koulas I, Solomon J, Qiu M, Leung T, Smith K, Ochani K, McGinn T, Spyropoulos AC. Universal clinical decision support tool for thromboprophylaxis in hospitalized COVID-19 patients: post hoc analysis of the IMPROVE-DD cluster randomized trial. Journal of Thrombosis and Haemostasis : Jth. 2024 Aug 14.

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Abstract:

BACKGROUND: Inpatient and extended postdischarge thromboprophylaxis of COVID-19 patients remains suboptimal despite antithrombotic guidelines. OBJECTIVES: To determine whether a novel electronic health record-agnostic clinical decision support (CDS) tool incorporating the International Medical Prevention Registry on Venous Thromboembolism plus D-dimer (IMPROVE-DD) venous thromboembolism (VTE) scores increases appropriate inpatient and extended postdischarge thromboprophylaxis and improves outcomes in COVID-19 inpatients. METHODS: This post hoc analysis of the IMPROVE-DD cluster randomized trial evaluated thromboprophylaxis CDS among COVID-19 inpatients at 4 New York hospitals between December 21, 2020, and January 21, 2022. Hospitals were randomized 1:1 to CDS (intervention, n  = 2) vs no CDS (usual care, n  = 2). The primary outcome was rate of appropriate thromboprophylaxis. Secondary outcomes included rates of major thromboembolism, all-cause and VTE-related readmissions and death, major bleeding (MB), and all-cause mortality 30 days after discharge. RESULTS: Two thousand four hundred fifty-two COVID-19 inpatients were analyzed (CDS, 1355; no CDS, 1097). Mean age was 73.7 ± 9.37 years; 50.1% of participants were male. CDS adoption was 96.8% (intervention group). CDS was associated with increased appropriate at-discharge extended thromboprophylaxis (42.6% vs 28.8%; odds ratio [OR], 1.83; 95% CI, 1.39-2.41; P  < .001). CDS was associated with reduced VTE (OR, 0.54; 95% CI, 0.39-0.75; P  < .001), arterial thromboembolism (OR, 0.10; 95% CI, 0.01-0.81; P  = .01), total thromboembolism (OR, 0.50; 95% CI, 0.36-0.69; P  < .001), and 30-day all-cause readmission/death (OR, 0.78; 95% CI, 0.62-0.99; P  = .04). There were no differences in MB, VTE-related readmissions/death, or all-cause mortality. CONCLUSION: Electronic health record-agnostic CDS incorporating IMPROVE-DD VTE scores had high adoption, was associated with increased appropriate at-discharge extended thromboprophylaxis, and reduced thromboembolism and all-cause readmission/death without increasing MB in COVID-19 inpatients.