title: High incidence of venous thromboembolism despite electronic alerts for thromboprophylaxis in hospitalised cancer patients.
abstract: Many cancer patients are at high risk of venous thromboembolism (VTE) during hospitalisation; nevertheless, thromboprophylaxis is frequently underused. Electronic alerts (e-alerts) have been associated with improvement in thromboprophylaxis use and a reduction of the incidence of VTE, both during hospitalisation and after discharge, particularly in the medical setting. However, there are no data regarding the benefit of this tool in cancer patients. Our aim was to evaluate the impact of a computer-alert system for VTE prevention in patients with cancer, particularly in those admitted to the Oncology/Haematology ward, comparing the results with the rest of inpatients at a university teaching hospital. The study included 32,167 adult patients hospitalised during the first semesters of years 2006 to 2010, 9,265 (28.8%) with an active malignancy. Appropriate prophylaxis in medical patients, significantly increased over time (from 40% in 2006 to 57% in 2010) and was maintained over 80% in surgical patients. However, while e-alerts were associated with a reduction of the incidence of VTE during hospitalisation in patients without cancer (odds ratio [OR] 0.31; 95% confidence interval [CI], 0.15-0.64), the impact was modest in cancer patients (OR 0.89; 95% CI, 0.42-1.86) and no benefit was observed in patients admitted to the Oncology/Haematology Departments (OR 1.11; 95% CI, 0.45-2.73). Interestingly, 60% of VTE episodes in cancer patients during recent years developed despite appropriate prophylaxis. Contrary to the impact on hospitalised patients without cancer, implementation of e-alerts for VTE risk did not prevent VTE effectively among those with malignancies.
authors.affiliation: Hematology Service, University Clinic of Navarra, Av. Pío XII, 36, 31008 Pamplona, Spain. rlecumber@unav.es
authors.forename: Ramón
authors.initials: R
authors.lastname: Lecumberri
authors.forename: Margarita
authors.initials: M
authors.lastname: Marqués
authors.forename: Elena
authors.initials: E
authors.lastname: Panizo
authors.forename: Ana
authors.initials: A
authors.lastname: Alfonso
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Mouriz
authors.forename: Ignacio
authors.initials: I
authors.lastname: Gil-Bazo
authors.forename: José
authors.initials: J
authors.lastname: Hermida
authors.forename: Sam
authors.initials: S
authors.lastname: Schulman
authors.forename: José A
authors.initials: JA
authors.lastname: Páramo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D058996:Quality Improvement; D012984:Software / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D006495:Heparin, Low-Molecular-Weight