FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

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

This article has been cited by other articles:

• Schnipper, J. L., Linder, J. A., Palchuk, M. B., Einbinder, J. S., Li, Q., Postilnik, A., Middleton, B. (2008). "Smart Forms" in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management. J. Am. Med. Inform. Assoc. 15: 513-523 [Abstract] [Full Text]  
• Lohrmann, J., Becker, R. C. (2008). New Anticoagulants -- The Path from Discovery to Clinical Practice. NEJM 358: 2827-2829 [Full Text]  
• Geerts, W. H., Bergqvist, D., Pineo, G. F., Heit, J. A., Samama, C. M., Lassen, M. R., Colwell, C. W. (2008). Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: 381S-453S [Abstract] [Full Text]  
• Haas, S., Spyropoulos, A. C. (2008). Primary Prevention of Venous Thromboembolism in Long-Term Care: Identifying and Managing the Risk. CLIN APPL THROMB HEMOST 14: 149-158 [Abstract]  
• Kakkar, N., Vasishta, R. K. (2008). Pulmonary Embolism in Medical Patients: An Autopsy-Based Study. CLIN APPL THROMB HEMOST 14: 159-167 [Abstract]  
• Fochtmann, L. J., Duffy, F. F., West, J. C., Kunkle, R., Plovnick, R. M. (2008). Performance in Practice: Sample Tools for the Care of Patients with Major Depressive Disorder. Focus 6: 22-35 [Abstract] [Full Text]  
• Roukema, J., Steyerberg, E. W., van der Lei, J., Moll, H. A. (2008). Randomized Trial of a Clinical Decision Support System: Impact on the Management of Children with Fever without Apparent Source. J. Am. Med. Inform. Assoc. 15: 107-113 [Abstract] [Full Text]  
• Lyman, G. H., Khorana, A. A., Falanga, A., Clarke-Pearson, D., Flowers, C., Jahanzeb, M., Kakkar, A., Kuderer, N. M., Levine, M. N., Liebman, H., Mendelson, D., Raskob, G., Somerfield, M. R., Thodiyil, P., Trent, D., Francis, C. W. (2007). American Society of Clinical Oncology Guideline: Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer. JCO 25: 5490-5505 [Abstract] [Full Text]  
• Lyman, G. H. (2007). ASCO Clinical Practice Guidelines and Beyond. J Oncol Pract 3: 330-331 [Full Text]  
• Khorana, A. A. (2007). The NCCN Clinical Practice Guidelines on Venous Thromboembolic Disease: Strategies for Improving VTE Prophylaxis in Hospitalized Cancer Patients. The Oncologist 12: 1361-1370 [Abstract] [Full Text]  
• Tapson, V. F., Decousus, H., Pini, M., Chong, B. H., Froehlich, J. B., Monreal, M., Spyropoulos, A. C., Merli, G. J., Zotz, R. B., Bergmann, J.-F., Pavanello, R., Turpie, A. G.G., Nakamura, M., Piovella, F., Kakkar, A. K., Spencer, F. A., FitzGerald, G., Anderson, F. A. Jr, for the IMPROVE Investigators, (2007). Venous Thromboembolism Prophylaxis in Acutely Ill Hospitalized Medical Patients: Findings From the International Medical Prevention Registry on Venous Thromboembolism. Chest 132: 936-945 [Abstract] [Full Text]  
• Piazza, G., Seddighzadeh, A., Goldhaber, S. Z. (2007). Double Trouble for 2,609 Hospitalized Medical Patients Who Developed Deep Vein Thrombosis: Prophylaxis Omitted More Often and Pulmonary Embolism More Frequent. Chest 132: 554-561 [Abstract] [Full Text]  
• Klebe, B., Farmer, C., Cooley, R., de Lusignan, S., Middleton, R., O'Donoghue, D., New, J., Stevens, P. (2007). Kidney disease management in UK primary care: guidelines, incentives and Information Technology. Fam Pract 24: 330-335 [Abstract] [Full Text]  
• Goldhaber, S. Z. (2007). Outpatient Venous Thromboembolism: A Common But Often Preventable Public Health Threat. Arch Intern Med 167: 1451-1452 [Full Text]  
• Harding, L. V, Dang, C., Young, R. (2007). Improving use. BMJ 334: 1128-1128 [Full Text]  
• Warwick, D., Friedman, R. J., Agnelli, G., Gil-Garay, E., Johnson, K., FitzGerald, G., Turibio, F. M. (2007). Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: FINDINGS FROM THE GLOBAL ORTHOPAEDIC REGISTRY. J Bone Joint Surg Br 89-B: 799-807 [Abstract] [Full Text]  
• Nutescu, E. A. (2007). Assessing, preventing, and treating venous thromboembolism: Evidence-based approaches. Am J Health Syst Pharm 64: S5-S13 [Abstract] [Full Text]  
• Francis, C. W. (2007). Prophylaxis for Thromboembolism in Hospitalized Medical Patients. NEJM 356: 1438-1444 [Full Text]  
• Haller, G., Myles, P. S., Stoelwinder, J., Langley, M., Anderson, H., McNeil, J. (2007). Integrating Incident Reporting into an Electronic Patient Record System. J. Am. Med. Inform. Assoc. 14: 175-181 [Abstract] [Full Text]  
• Kheterpal, S., Gupta, R., Blum, J. M., Tremper, K. K., O'Reilly, M., Kazanjian, P. E. (2007). Electronic Reminders Improve Procedure Documentation Compliance and Professional Fee Reimbursement. Anesth. Analg. 104: 592-597 [Abstract] [Full Text]  
• Nelson, K. B. (2007). Perinatal Ischemic Stroke. Stroke 38: 742-745 [Abstract] [Full Text]  
• Yu, H.-T., Dylan, M. L., Lin, J., Dubois, R. W. (2007). Hospitals' compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm 64: 69-76 [Abstract] [Full Text]  
• Bobb, A. M., Payne, T. H., Gross, P. A. (2007). Viewpoint: Controversies Surrounding Use of Order Sets for Clinical Decision Support in Computerized Provider Order Entry. J. Am. Med. Inform. Assoc. 14: 41-47 [Abstract] [Full Text]  
• Turpie, A. G G, Leizorovicz, A. (2006). Prevention of venous thromboembolism in medically ill patients: a clinical update. Postgrad. Med. J. 82: 806-809 [Abstract] [Full Text]  
• O'Shaughnessy, D., Rose, P., Pressley, F., Scriven, N., Farren, T., Nokes, T., Arya, R. (2006). Evaluating the Performance of a Previously Reported Risk Score To Predict Venous Thromboembolism: A VERITY Registry Study.. ASH ANNUAL MEETING ABSTRACTS 108: 716-716 [Abstract] [Full Text]  
• Sellier, E., Labarere, J., Bosson, J.-L., Auvray, M., Barrellier, M.-T., Le Hello, C., Belmin, J., Le Roux, P., Sevestre, M.-A., for the Association pour la Promotion de l'Angiolo, (2006). Effectiveness of a guideline for venous thromboembolism prophylaxis in elderly post-acute care patients: a multicenter study with systematic ultrasonographic examination.. Arch Intern Med 166: 2065-2071 [Abstract] [Full Text]  
• Burleigh, E., Wang, C., Foster, D., Heller, S., Dunn, D., Safavi, K., Griffin, B., Smith, J. (2006). Thromboprophylaxis in medically ill patients at risk for venous thromboembolism.. Am J Health Syst Pharm 63: S23-S29 [Abstract] [Full Text]  
• Piazza, G., Goldhaber, S. Z. (2006). Acute Pulmonary Embolism: Part II: Treatment and Prophylaxis. Circulation 114: e42-e47 [Full Text]  
• Wachter, R. M. (2006). Expected and Unanticipated Consequences of the Quality and Information Technology Revolutions. JAMA 295: 2780-2783 [Full Text]  
• Pronovost, P, Wachter, R (2006). Proposed standards for quality improvement research and publication: one step forward and two steps back.. Qual Saf Health Care 15: 152-153 [Full Text]  
• Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., Morton, S. C., Shekelle, P. G. (2006). Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care. ANN INTERN MED 144: 742-752 [Abstract] [Full Text]  
• Berner, E. S., Houston, T. K., Ray, M. N., Allison, J. J., Heudebert, G. R., Chatham, W. W., Kennedy, J. I. Jr., Glandon, G. L., Norton, P. A., Crawford, M. A., Maisiak, R. S. (2006). Improving Ambulatory Prescribing Safety with a Handheld Decision Support System: A Randomized Controlled Trial. J. Am. Med. Inform. Assoc. 13: 171-179 [Abstract] [Full Text]  
• (2006). Appendix A: Errata. ASH Education Book 2006: 502-502 [Full Text]  
• Garg, A. X., Tonelli, M. (2005). The Tension Between E-Health Innovation and E-Valuation. Arch Intern Med 165: 2329-2330 [Full Text]  
• Perrin, K., Robinson, P., Beasley, R. (2005). Venous thromboembolism in medical inpatients--the silent epidemic of neglect. JRSM 98: 484-485 [Full Text]  
• Krumholz, H. M. (2005). The Year in Epidemiology, Health Services, and Outcomes Research. J Am Coll Cardiol 46: 1362-1370 [Full Text]  
• Sandberg, W. S., Hakkinen, M., Egan, M., Curran, P. K., Fairbrother, P., Choquette, K., Daily, B., Sarkka, J.-P., Rattner, D. (2005). Automatic Detection and Notification of "Wrong Patient--Wrong Location" Errors in the Operating Room. SURG INNOV 12: 253-260 [Abstract]  
• Brophy, D. F, Dougherty, J. A, Garrelts, J. C, Parish, R. C, Rivey, M. P, Stumpf, J. L, Taylor, C. T, Mathis, A S. (2005). Venous Thromboembolism Prevention in Acutely Ill Nonsurgical Patients. The Annals of Pharmacotherapy 39: 1318-1324 [Abstract] [Full Text]  
• Lee, B. Y., Chen, E. H., White, R. H., Keenan, C. R., Kaboli, P. J., Kucher, N., Goldhaber, S. Z. (2005). Electronic Alerts to Prevent Venous Thromboembolism. NEJM 352: 2349-2350 [Full Text]  
• (2005). Electronic Alerts Improve VTE Prophylaxis. Journal Watch Cardiology 2005: 6-6 [Full Text]  
• (2005). Computer Alerts to Improve Prophylaxis Against VTE. JWatch General 2005: 3-3 [Full Text]  
• Tonks, A. (2005). What's new in the other general journals. BMJ 330: 623-624 [Full Text]  
• Durieux, P. (2005). Electronic Medical Alerts -- So Simple, So Complex. NEJM 352: 1034-1036 [Full Text]  
• Prandoni, P. (2005). Acquired Risk Factors for Venous Thromboembolism in Medical Patients. ASH Education Book 2005: 458-461 [Abstract] [Full Text]