A team at the Feinstein Institutes for Medical Research report they have developed a new digital tool that can assess and reduce the risk of often life-threatening post-hospitalization blood clots from patients who have been admitted for such health problems as stroke or COVID-19. The results of the researcher’s clinical trial were presented recently at the American Heart Association’s Scientific Sessions 2022 in Chicago and could provide significantly improved outcomes for the more than eight million people in the United States who are afflicted by these blood clots.
“Either in the hospital or in the immediate post-discharge period, armed with the right clinical decision tool, physicians can properly prevent dangerous blood clots in hospitalized medically ill patients,” said Alex C. Spyropoulos, MD, professor at the Institute of Health System Science at the Feinstein Institutes. “This new digital platform is not only able to identify at-risk and high-risk medical patients to increase rates of appropriate thromboprophylaxis, but for the first time shows that use of this tool actually decreases hard outcomes, namely thrombotic events. The results of our trial using this innovative technology have implications not only for our large health system, but globally as well in a very large at-risk hospitalized population.”
The digital platform, developed within the informatics group at Feinstein’s Institute for Health System Sciences, leveraged the clinical decision support tool Evidence-Point, which incorporated IMPROVE-DD VTE, a validated thrombosis risk score. The new platform uses the risk score with data from a patient’s electronic health record (EHR) to assess the patient’s risk of blood clots forming in the vein—called venous thromboembolism, or VTE— both in the hospital and in the immediate post-discharge period. Using this information, treating physicians can prescribe the necessary thromboprophylaxis, or clot preventative medicine, to help those patients avoid thrombosis—both VTE and arterial thromboembolism (ATE)—that include strokes, myocardial infarctions, and systemic clots.
Clinical trial data on the use of the tool showed a 50% increase in the use of appropriate thromboprophylaxis for patients deemed moderate-risk for VTE or ATE and a nearly two-fold increase for high-risk patients using extended prophylaxis at hospital discharge. These preventative measures reduced VTE by 20% and ATE was even more significantly reduced by 65% in the intervention group that used the tool compared with the control hospital group that received usual care. Further, the investigator reported there was no increase in major bleeding among the patients, a possible side effect of thromboprophylaxis, as doctors were also able to properly dose the patients.
“Early recognition and diagnosis can prevent serious and even fatal complications of blood clots,” said Kevin J. Tracey, MD, president and CEO of the Feinstein Institutes. “Dr. Spyropoulos and colleagues discovered how to harness digital technology to guide decision making and identify those patients who benefit most from early intervention.”
The team at Feinstein is hopeful the tool can be used to standardize predicting patient risk from low-risk, medium-risk, to high-risk patients, as there is currently no standard procedure for this stratification and other methods have failed to show reductions in VTE. The tool, using the IMPROVE-DD VTE score, integrates clinical decision support using technology that can be adapted into any EHR and displays an appropriate prophylaxis regimen, which is then recorded in the EHR.
The results are still pending peer review, but it is anticipated they will be published shortly after the American Heart Association’s Scientific Sessions 2022 in the journal Circulation.