title: Randomized trial of physician alerts for thromboprophylaxis after discharge.
abstract: BACKGROUND
  Many hospitalized Medical Service patients are at risk for venous thromboembolism in the months after discharge. We conducted a multicenter randomized controlled trial to test whether a hospital staff member's thromboprophylaxis alert to an Attending Physician before discharge will increase the rate of extended out-of-hospital prophylaxis and, in turn, reduce the incidence of symptomatic venous thromboembolism at 90 days.
  
  
  METHODS
  From April 2009 to January 2010, we enrolled hospitalized Medical Service patients using the point score system developed by Kucher et al to identify those at high risk for venous thromboembolism who were not ordered to receive thromboprophylaxis after discharge. There were 2513 eligible patients from 18 study sites randomized by computer in a 1:1 ratio to the alert group or the control group.
  
  
  RESULTS
  Patients in the alert group were more than twice as likely to receive thromboprophylaxis at discharge as controls (22.0% vs 9.7%, P <.0001). Based on an intention-to-treat analysis, symptomatic venous thromboembolism at 90 days (99.9% follow-up) occurred in 4.5% of patients in the alert group, compared with 4.0% of controls (hazard ratio 1.12; 95% confidence interval, 0.74-1.69). The rate of major bleeding at 30 days in the alert group was similar to that of the control group (1.2% vs 1.2%, hazard ratio 0.94; 95% confidence interval, 0.44-2.01).
  
  
  CONCLUSIONS
  Alerting providers to extend thromboprophylaxis after hospital discharge in Medical Service patients increased the rate of prophylaxis but did not decrease the rate of symptomatic venous thromboembolism.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Piazza
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cox
authors.forename: David J
authors.initials: DJ
authors.lastname: Rosenberg
authors.forename: Shahram
authors.initials: S
authors.lastname: Rahimian
authors.forename: William J
authors.initials: WJ
authors.lastname: Pendergast
authors.forename: Gordon D
authors.initials: GD
authors.lastname: McLaren
authors.forename: James A
authors.initials: JA
authors.lastname: Welker
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Akus
authors.forename: Scott M
authors.initials: SM
authors.lastname: Stevens
authors.forename: C Gregory
authors.initials: CG
authors.lastname: Elliott
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Freeman
authors.forename: William F
authors.initials: WF
authors.lastname: Patton
authors.forename: Ousama
authors.initials: O
authors.lastname: Dabbagh
authors.forename: Allison
authors.initials: A
authors.lastname: Wyman
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Rao
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D010351:Patient Discharge; D010820:Physicians; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants