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Previous Volume 352:969-977 March 10, 2005 Number 10 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Durieux, P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Prophylaxis against deep-vein thrombosis in hospitalized patients remains underused. We hypothesized that the use of a computer-alert program to encourage prophylaxis might reduce the frequency of deep-vein thrombosis among high-risk hospitalized patients.

Methods We developed a computer program linked to the patient database to identify consecutive hospitalized patients at risk for deep-vein thrombosis in the absence of prophylaxis. The program used medical-record numbers to randomly assign 1255 eligible patients to an intervention group, in which the responsible physician was alerted to a patient's risk of deep-vein thrombosis, and 1251 patients to a control group, in which no alert was issued. The physician was required to acknowledge the alert and could then withhold or order prophylaxis, including graduated compression stockings, pneumatic compression boots, unfractionated heparin, low-molecular-weight heparin, or warfarin. The primary end point was clinically diagnosed, objectively confirmed deep-vein thrombosis or pulmonary embolism at 90 days.

Results More patients in the intervention group than in the control group received mechanical prophylaxis (10.0 percent vs. 1.5 percent, P<0.001) or pharmacologic prophylaxis (23.6 percent vs. 13.0 percent, P<0.001). The primary end point occurred in 61 patients (4.9 percent) in the intervention group, as compared with 103 (8.2 percent) in the control group; the Kaplan–Meier estimates of the likelihood of freedom from deep-vein thrombosis or pulmonary embolism at 90 days were 94.1 percent (95 percent confidence interval, 92.5 to 95.4 percent) and 90.6 percent (95 percent confidence interval, 88.7 to 92.2 percent), respectively (P<0.001). The computer alert reduced the risk of deep-vein thrombosis or pulmonary embolism at 90 days by 41 percent (hazard ratio, 0.59; 95 percent confidence interval, 0.43 to 0.81; P=0.001).

Conclusions The institution of a computer-alert program increased physicians' use of prophylaxis and markedly reduced the rates of deep-vein thrombosis and pulmonary embolism among hospitalized patients at risk.

Source Information

From the Departments of Medicine (N.K., S.K., R.Q., S.Z.G.), Cardiovascular Division, Harvard Medical School and Brigham and Women's Hospital, Boston; the Department of Medicine, University of Pennsylvania Medical Center, Philadelphia (J.M.C.); and Partners HealthCare System, Wellesley, Mass. (M.D.P., B.S.).

Address reprint requests to Dr. Goldhaber at the Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at sgoldhaber{at}partners.org.

Full Text of this Article

Related Letters:

Electronic Alerts to Prevent Venous Thromboembolism
Lee B. Y., Chen E. H., White R. H., Keenan C. R., Kaboli P. J., Kucher N., Goldhaber S. Z.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:2349-2350, Jun 2, 2005. Correspondence

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