High incidence of venous thromboembolism despite electronic alerts for thromboprophylaxis in hospitalised cancer patients

Ramón Lecumberri; Margarita Marqués; Elena Panizo; Ana Alfonso; Alberto García-Mouriz; Ignacio Gil-Bazo; José Hermida; Sam Schulman; José A. Páramo

doi:10.1160/TH13-02-0131

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2013; 110(01): 184-190
DOI: 10.1160/TH13-02-0131

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

High incidence of venous thromboembolism despite electronic alerts for thromboprophylaxis in hospitalised cancer patients

Ramón Lecumberri

¹Hematology Service, University Clinic of Navarra, Pamplona, Spain

,

Margarita Marqués

²Documentation Service, University Clinic of Navarra, Pamplona, Spain

,

Elena Panizo

¹Hematology Service, University Clinic of Navarra, Pamplona, Spain

,

Ana Alfonso

¹Hematology Service, University Clinic of Navarra, Pamplona, Spain

,

Alberto García-Mouriz

³Informatics Service, University Clinic of Navarra, Pamplona, Spain

,

Ignacio Gil-Bazo

⁴Oncology Department, University Clinic of Navarra, Pamplona, Spain

,

José Hermida

⁵Division of Cardiovascular Sciences, Centre of Applied Medical Research, University of Navarra, Pamplona, Spain

,

Sam Schulman

⁶Department of Medicine, McMaster University, Hamilton, Ontario, Canada

,

José A. Páramo

¹Hematology Service, University Clinic of Navarra, Pamplona, Spain

› Author Affiliations

Abstract

Summary

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.

Keywords

Venous thromboembolism - cancer - hospitalised patients - electronic alerts - prophylaxis

Full Text

References

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