Clot Chronicles: Dr. Spyropoulos Discusses an IMPROVE-DD Venous Case Study

Welcome to Clot Chronicles, a series highlighting contributions from our Executive and Medical Advisory Boards to keep you up to date on the latest thrombosis research. Along with concise, clinically focused summaries, you’ll also have access to videos featuring our board members and their work.

In our inaugural video, Alex Spyropoulos, MD discusses his recently published cluster randomized trial in JACC: Advances. This study, the largest of its kind, explores the impact of universal Electronic Health Record (EHR)-embedded Clinical Decision Support (CDS) on VTE risk management in medically ill patients.

CLINICAL PERSPECTIVES

Competency in Medical Knowledge

This cluster randomized trial is the largest multicenter study to date investigating the impact of universal EHR-embedded CDS using a validated venous thromboembolism risk score on rates of appropriate thromboprophylaxis (both during hospitalization and at-discharge) and major thromboembolism in medically-ill patients.

Competency in Patient Care:

In 10,699 medically ill patients at four tertiary academic hospitals, an EHR-embedded IMPROVE-DD VTE CDS tool had high adoption (77.8%), increased appropriate thromboprophylaxis during hospitalization (80.1% versus 72.5%) and at discharge (13.6% versus 7.5%) versus usual care, and reduced major thromboembolism without increasing major bleeding. Mortality was higher at intervention sites. 

Translational Outlook 1:

A universal thromboprophylaxis CDS tool anchored on a validated VTE risk score (IMPROVE-DD) can increase appropriate thromboprophylaxis and reduce major thromboembolism in hospitalized medical inpatients if embedded within provider workflow during hospitalization and at discharge.

Translational Outlook 2:

• These benefits may be more robust in lower performance hospitals for medical inpatient thromboprophylaxis outside of academic settings.
• A broad impact can be achieved as the CDS tool is interchangeable among different EHRs.

Video

Alex Spyropoulos, MD discusses his recently published cluster randomized trial in JACC: Advances