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Computer alert markedly reduces venous clots in hospitalized patients

Last Updated: 2005-03-09 17:00:07 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - A computer alert system can dramatically reduce the occurrence of deep-vein thrombosis (DVT) and pulmonary embolism (PE) among hospitalized patients, according to a report in The New England Journal of Medicine for March 10th.

With the system, a warning that a particular patient is at high risk for venous thromboembolism appears on the computer screen when a physician logs in to enter orders. To dismiss the warning, the physician must complete a few screens that provide the opportunity to order prophylactic treatment.
"We were just flabbergasted in a very joyous way about the results of this trial," senior author Dr. Samuel Z. Goldhaber, from Brigham and Women's Hospital in Boston, told Reuters Health. Not only did the alert system drastically cut the risk of DVT and PE, "there was no increase in major or minor bleeding complications."

"As far as I know, no other study looking at order alert systems has ever shown that you can reduce the rate of DVT and PE. Past studies have shown that you could increase the number of orders written [for prophylactic measures], but they weren't really powered" to determine if the rates of thromboembolic events fell, Dr. Goldhaber explained.

The study involved 2506 hospitalized patients who were at high risk of venous thromboembolism and were randomly assigned to the alert group or to a control group, in which no special alert was issued.

Mechanical prophylaxis rates in the alert and control groups were 10.0% and 1.5%, respectively (p < 0.001). The corresponding rates of pharmacologic prophylaxis were 23.6% and 13.0% (p < 0.001).

The rate of the primary end-point, confirmed DVT or PE at 90 days, was 4.9% in the alert group, much lower than the 8.2% rate seen in the control group. This translated into a 41% reduction in risk with the alert intervention (p = 0.001).

As good as the results were, Dr. Goldhaber said there is still room for improvement. "Two thirds of the time, our alert was killed" without the physician ordering any prophylactic measures, he said. "I think the next step will be to delve into this issue a little bit more."

In a related editorial, Dr. Pierre Durieux, from Hopital Europeen Georges Pompidou in Paris, notes that "it is important to remember that clinical alerts are tools that help but do not transform the decision-making process. Ultimately, the physician, not the computer, makes the decision."

N Engl J Med 2005;352:969-977,1034-1035.