Using alerts to help doctors prescribe blood thinners at hospital discharge
eVTE (Electronic Venous Thromboembolism): A Cluster, Randomized, Step-wedge Type II Hybrid Study of an Alert Recommending Extended Duration Thromboprophylaxis for At-risk Discharging Medical Patients to Prevent VTE.
This study is testing whether a new alert system can help doctors remember to prescribe a blood thinner called rivaroxaban for patients at high risk of blood clots when they leave the hospital.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 152000 (estimated) |
| Ages | 18 Years to 110 Years |
| Sex | All |
| Sponsor | Intermountain Health Care, Inc. Academic / other |
| Locations | 1 site (Murray, Utah) |
| Trial ID | NCT06232551 on ClinicalTrials.gov |
What this trial studies
This study evaluates a new algorithm that identifies hospitalized patients at high risk for blood clots but low risk for bleeding. When these patients are discharged, a pop-up alert will notify clinicians to consider prescribing rivaroxaban, a blood thinner, for extended duration thromboprophylaxis. The study will compare the rates of rivaroxaban prescriptions before and after the alert is implemented, as well as measure clinical outcomes related to blood clots and bleeding. The approach involves a cluster randomized design where hospitals will be introduced to the alert in a sequential manner.
Who should consider this trial
Good fit: Ideal candidates are hospitalized patients aged 18 and older who are at increased risk for venous thromboembolism but have a low risk of bleeding.
Not a fit: Patients who are actively prescribed other anticoagulants or are pregnant during their hospital stay will not benefit from this study.
Why it matters
Potential benefit: If successful, this approach could significantly reduce the incidence of venous thromboembolism in at-risk patients after hospital discharge.
How similar studies have performed: Other studies have shown promise in using alerts to improve clinical decision-making, suggesting this approach could be effective.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Discharging clinician must be in one of the following iCentra electronic health record (Cerner, Kansas City, MO) positions: * Physician, nurse practitioner, or physician assistant hospitalist * Physician internal medicine * Physician family medicine * Patient age ≥ 18 years. * The encounter must be inpatient. * A signed hospital discharge order must be present. * eVTE target population criteria (increased venous thromboembolism risk, low bleeding risk) must be met Exclusion Criteria: * Pregnant during encounter * Discharge order completed by ineligible clinician type * Exclude all cases where the patient is being actively prescribed and intended to be discharged on the following qualifying anticoagulant medications, regardless of dose form or dosing regimen (i.e., they have an active prescription for one of these medications): * Apixaban * Dabigatran * Dalteparin * Enoxaparin * Edoxaban * Betrixaban * Fondaparinux * Rivaroxaban * Warfarin * Creatinine clearance \<30 milliliters/minute based on last-available eligible serum creatinine value preceding discharge * Estimated creatine clearance based on actual body weight (preferred) ((140 - age years) \* measured weight kilograms) / (72.0 \* serum creatine milligrams/deciliter) (\*0.85 if female)) = milliliters/minute * If measured body weight not available, then based on ideal body weight ((140 - age years) \* ideal body weight kilograms) / (72.0 \* serum creatine milligrams/deciliter) (\*0.85 if female)) = milliliters/minute
Where this trial is running
Murray, Utah
- Intermountain Medical Center — Murray, Utah, United States (Recruiting)
Study contacts
- Principal investigator: Scott C. Woller, MD — Intermountain Health
- Study coordinator: Valerie Aston, MBA
- Email: valerie.aston@imail.org
- Phone: 801-507-4606
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.