title: Multifaceted Intervention to Prevent Venous Thromboembolism in Patients Hospitalized for Acute Medical Illness: A Multicenter Cluster-Randomized Trial.
abstract: Misuse of thromboprophylaxis may increase preventable complications for hospitalized medical patients.
  
  
  
  To assess the net clinical benefit of a multifaceted intervention in emergency wards (educational lectures, posters, pocket cards, computerized clinical decision support systems and, where feasible, electronic reminders) for the prevention of venous thromboembolism.
  
  
  
  Prospective cluster-randomized trial in 27 hospitals. After a pre-intervention period, centers were randomized as either intervention (n = 13) or control (n = 14). All patients over 40 years old, admitted to the emergency room, and hospitalized in a medical ward were included, totaling 1,402 (712 intervention and 690 control) and 15,351 (8,359 intervention and 6,992 control) in the pre-intervention and intervention periods, respectively.
  
  
  
  Symptomatic venous thromboembolism or major bleeding (primary outcome) occurred at 3 months in 3.1% and 3.2% of patients in the intervention and control groups, respectively (adjusted odds ratio: 1.02 [95% confidence interval: 0.78-1.34]). The rates of thromboembolism (1.9% vs. 1.9%), major bleedings (1.2% vs. 1.3%), and mortality (11.3% vs. 11.1%) did not differ between the groups. Between the pre-intervention and intervention periods, the proportion of patients who received prophylactic anticoagulant treatment more steeply increased in the intervention group (from 35.0% to 48.2%: +13.2%) than the control (40.7% to 44.1%: +3.4%), while the rate of adequate thromboprophylaxis remained stable in both groups (52.4% to 50.9%: -1.5%; 49.1% to 48.8%: -0.3%).
  
  
  
  Our intervention neither improved adequate prophylaxis nor reduced the rates of clinical events. New strategies are required to improve thromboembolism prevention for hospitalized medical patients.
  
  
  
  ClinicalTrials.gov NCT01212393.
authors.affiliation: Département de Médecine d'Urgence, Centre Vasculaire et de la Coagulation, CHU Angers, Institut MITOVASC, EA3860, Université d'Angers, Angers, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Roy
authors.affiliation: Unité d'Épidémiologie et de Recherche Clinique, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre d'investigation Épidémiologique 4, INSERM, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rachas
authors.affiliation: Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, INSERM U 970, CIC 1418, Paris, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.affiliation: Département de Médecine Interne et Pneumologie, CHU de la Cavale Blanche, Université de Bretagne Occidentale, EA3878 (GETBO), CIC INSERM 1412, Brest, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Le Gal
authors.affiliation: Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMRS 872, Centre de recherche des Cordeliers, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Durieux
authors.affiliation: Service des Urgences, Médecine Polyvalente, CHU Hôtel Dieu, Nantes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: El Kouri
authors.affiliation: Département de Médecine d'Urgence, CHU Dijon, Hôpital du Bocage, Dijon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Honnart
authors.affiliation: Service d'Accueil des Urgences, CHU Gabriel Montpied, Université de Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Jeannot
authors.initials: J
authors.lastname: Schmidt
authors.affiliation: Service des Urgences, CH Argenteuil Victor Dupouy, Argenteuil, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Legall
authors.affiliation: Service des Urgences, CHU La Pitié Salpétrière, Assistance Publique Hôpitaux de Paris, Université Paris 06 UPMC, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hausfater
authors.affiliation: Délégation à la recherche clinique et innovation, cellule de gestion des données et évaluation, CHU Angers, Angers, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Chrétien
authors.affiliation: Département de Médecine Interne et Pneumologie, CHU de la Cavale Blanche, Université de Bretagne Occidentale, EA3878 (GETBO), CIC INSERM 1412, Brest, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Mottier
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D054556:Venous Thromboembolism / Q000401:mortality / Q000517:prevention & control*