Long-term effect of Padua-Clinical Decision Support on thromboprophylaxis guideline adherence: a prospective cohort study

Abstract Background: Prescription of Low Molecular Weight Heparins according to the thromboprophylaxis guideline reduces the venous thromboembolism (VTE) incidence in non-surgical hospitalised patients with 80%. To increase guideline adherence, we previously implemented a Clinical Decision Support (CDS) rule based on the Padua score (hereafter: Padua-CDS) in our hospital. Aim: To determine the effect of the Padua-CDS on thromboprophylaxis guideline adherence two years after implementation (T2), compared to pre-implementation (T0) and immediately after implementation (T1). Methods: We performed a prospective cohort study in non-surgical patients and compared to previous measurements before and after implementation. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. Logistic regression analysis was used to analyse the results. Results: 85 patients were included in T2, the same number of patients previously collected in T0 and T1. Guideline adherence was 81.2%, compared to 49.4% in T0 (OR 4.42, 95%CI 2.21-8.81) and 82.4% in T1 (OR 0.92; 95%CI 0.42-2.01). Guideline adherence in patients with a high VTE risk without bleeding risk was 90.7%, compared to 45.5% in T0 and 84.3% in T1. Conclusion: Thromboprophylaxis guideline adherence was still significantly increased two years after implementation of the Padua-CDS, demonstrating a sustained effect.