Alerting Providers at Patient Hospital Discharge to Consider Prescribing Rivaroxaban to Reduce Venous Thromboembolism

Launched by SCOTT C. WOLLER, MD · Jan 29, 2024

Keywords

ClinConnect Summary

This clinical trial is investigating a new system that alerts doctors when patients are getting ready to leave the hospital. The alert is designed for patients who have a higher chance of developing dangerous blood clots, but low risk of bleeding. The goal is to see if this alert encourages doctors to prescribe a blood thinner called rivaroxaban, which can help prevent blood clots like deep vein thrombosis and pulmonary embolism.

To be eligible for this trial, patients need to be at least 18 years old and must have been admitted to the hospital, with a discharge order signed by a qualified healthcare provider. Pregnant patients and those already on certain blood thinners cannot participate. If you join the study, you can expect to have your medical team monitor your risk for blood clots and bleeding to ensure safe and effective care during your hospital discharge. The results will help improve how hospitals manage the risk of blood clots for patients in the future.

Gender

ALL

Eligibility 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