A new algorithm derived from only patient age and components of the complete blood count and basic metabolic panel can identify patients discharged from the hospital who may benefit from a blood thinner (called rivaroxaban) to decrease their risk of blood clots, and for whom the risk of bleeding is minimal.
The purpose of this study is to evaluate the use of a pop-up alert, which will be seen by clinicians when a discharging patient has been identified as being someone for whom the risk of blood clots is high, but for whom bleeding risk is estimated to be low.
The pop-up alert will be enabled in a sequential fashion for each group of hospitals in 1 month blocks. We will look to see if the pop-up alert changes the number of patients who receive rivaroxaban. We will also measure the outcomes of blood clots and bleeding among all discharging patients.
Physician, nurse practitioner, or physician assistant hospitalist
Physician internal medicine
Physician family medicine
Patient age ≥ 18 years.
Pregnant during encounter
Discharge order completed by ineligible clinician type
Apixaban
Dabigatran
Sequential
EHR (electronic health record) alert
Other interventionPop-up alert that informs the discharging clinician that the patient meets criteria to be considered for extended duration thromboprophylaxis
No EHR (electronic health record) alert
Other interventionDuring the baseline phase while risk is assessed and stored, no alerting occurs
Primary outcome (implementation)
Proportion of rivaroxaban prescriptions sent during the intervention phase, compared to the baseline phase
Primary clinical efficacy outcome (effectiveness)
Composite of 90-day venous thromboembolism, myocardial infarction, non-hemorrhagic stroke, or death during the intervention phase for those patients for whom an alert was generated, compared to eligible at-risk patients during the baseline phase for whom no alert was generated
Primary clinical safety outcome
30 day major bleeding during the intervention phase for those patients for whom an alert was generated and a prescription was sent, compared to eligible at-risk patients during the baseline phase for whom no alert was generated
Click on the lead sponsor to view all of their trials.
Scott C. Woller, MD
Lead sponsor
Intermountain Health Care, Inc.
Sponsor institution
Janssen Pharmaceuticals
Collaborator
