Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciences0869-60472414-3545"Paediatrician" Publishers LLC125210.15690/vramn1252Research ArticleImplementation of clinical decision support system for anticoagulant prescribing for patients with deep vein thrombosisChernovAnton A.sbornaya1med@yandex.ruhttps://orcid.org/0000-0001-6209-387XKleymenovaE. B.<p class="MsoNormal">MD, PhD</p>e.kleymenova@gmail.comhttps://orcid.org/0000-0002-8745-6195SychevDmitry A.<p class="MsoNormal">MD, PhD, Professor</p>dmitrysychevrmapo@gmail.comhttps://orcid.org/0000-0002-4496-3680YashinaLiubov P.<p class="MsoNormal">PhD</p>lyashina1@yandex.ruhttps://orcid.org/0000-0003-1357-0056NigmatkulovaMaria D.evagrigor@yandex.ruhttps://orcid.org/0000-0001-8840-4904OtdelenovVitaly A.<p>MD, PhD</p>vitotd@ya.ruhttps://orcid.org/0000-0003-0623-7263YashinaL. P.<p class="MsoNormal">PhD</p>svetlanapay@gmail.comhttps://orcid.org/0000-0002-7350-0423General Medical Center of the Bank of RussiaRussian Medical Academy of Continuing Professional EducationFederal Research Center «Computer Science and Control» of the Russian Academy of Sciences3003202075169762111201910022020Copyright © 2020, "Paediatrician" Publishers LLC2020<p><strong>Background</strong>: Physicians adherence to recommendations for appropriate antithrombotic therapy of venous thromboembolism (VTE) can reduce the risk of recurrent VTE, pulmonary hypertension, bleeding and other adverse events. Clinical decision support systems (CDSS) are shown to increase physicians adherence to clinical guidelines.</p>
<p><strong>Aims</strong>: To assess effectivenes and safety of CDSS for anticoagulant prescribing for inhospital patients with VTE.</p>
<p><strong>Methods</strong>: A prospective cohort study was conducted in a Moscow general hospital from 06.30.2017 to 06.23.2018 to compare physicians compliance with clinical guidelines for DVT anticoagulant therapy, the rate of drug errors and direct costs of anticoagulant therapy before and after CDSS implementation (55 patients in control group and 49 in experimental group).</p>
<p><strong>Results</strong>: The rate of anticoagulant prescribing for patients with DVT did not alter significantly after CDSS implementation (96% compared with 91% before CDSS), but physicians compliance with recommendations on anticoagulant dosage increased from 32.7% to 73.5% (p = 0.0003) with corresponding decrease in the rate of anticoagulant prescribing errors from 1.35 to 0.65 per 1 patient (p = 0.0005). The length of stay and hemorrhagic complication rate did not differ between control and experimental groups. LMWH replacement with new oral anticoagulants has reduced the cost of anticoagulant therapy for 1 patient from 11.800 rubles (IQR = 7000) to 5.430 rubles (IQR = 5700) (p 0.005).</p>
<p><strong>Conclusions:</strong> СDSS can increase physicians adherence to recommended anticoagulant therapy for patients with DVT: to prevent unreasonable under-/overdosing or prolongation of anticoagulant therapy. CDSS for DVT drug therapy can be economically feasible.</p>anticoagulantsdeep vein thrombosisclinical decision support systemguideline adherenceантикоагулянтытромбоз глубоких венсистема поддержки принятия решениянежелательные лекарственные событияприверженность клиническим рекомендациям[Wendelboe AM, Raskob GE. Global burden of thrombosis; epidemiologic aspects. Circ Res. 2016;118(9):1340–1347. doi: 10.1161/CIRCRESAHA.115.306841.][Cohen AT, Agnelli G, Anderson FA, et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98(10):756–764. doi: 10.1160/th07-03-0212.][Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Thromb Res. 2014;134(5):931–938. doi: 10.1016/j.thromres.2014.08.014.][National Institute for Health and Care Excellence (NICE). Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Guidance. NICE; 2019 [cited 2018 March]. Available from: https://www.nice.org.uk/Guidance/NG89.][Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis. 9th ed: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e419S–e496S. doi: 10.1378/chest.11-2301.][Feehan M, Walsh M, van Duker H, et al. Prevalence and correlates of bleeding and emotional harms in a national US sample of patients with venous thromboembolism: A cross-sectional structural equation model. Thromb Res. 2018;172:181−187. doi: 10.1016/j.thromres.2018.05.025.][Smetzer JL, Cohen MR. Medication error reporting systems. Chapter 19. In: Medication errors. 2nd ed. Washington, DC: American Pharmacists Association; 2007. Рр. 513−550. doi: 10.21019/9781582120928.ch19.][Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med. 2010;38(4 Suppl):S495−S501. doi: 10.1016/j.amepre.2009.12.017.][Martinez K, Kosirog E, Billups SJ, et al. Clinical outcomes and adherence to guideline recommendations during the initial treatment of acute venous thromboembolism. Ann Pharmacother. 2015;49(8):869−875. doi: 10.1177/1060028015583892.][Beeler PE, Kucher N, Blaser J, et al. Sustained impact of electronic alerts on rate of prophylaxisagainst venous thromboembolism. Thromb Haemost. 2011;106(4):734−738. doi: 10.1160/TH11-04-0220.][Назаренко Г.И., Пающик С.А., Отделенов В.А., и др. Оптимизация профилактики венозных тромбозов и эмболий в стационаре с использованием информационных технологий // Рациональная фармакотерапия в кардиологии. ― 2014. ― Т.10. ― №4. ― С. 425−431. [Nazarenko GI, Payushik SA, Otdelenov VA, et al. Optimal prevention of hospital venous thromboembolism with the help of medical information system. Rational pharmacotherapy in cardiology. 2014;10(4):425−431. (In Russ).]][Назаренко Г.И., Клейменова Е.Б., Жуйков М.Ю., и др. Система автоматизации клинических руководств и лечения // Врач и информационные технологии. ― 2014. ― №2. ― С. 23−32. [Nazarenko GI, Kleymenova EB, Zhujkov MYu, et al. System of Computer-interpretable clinical guidelines and treatment audit. Vrach i informacionnye tehnologii. 2014;(2):23−32. (In Russ).]][Kearon C, Akl EA, Ornelas J. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315−352. doi: 10.1016/j.chest.2015.11.026.][Бокерия Л.А. Затевахин И.И., Кириенко А.И., и др. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений // Флебология. ― 2015. ― Т.9. ― №4-2. ― С. 1−52. [Bokeria LA, Zatevakhin II, Kirienko AI, et al. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications. Flebologiia. 2015;9(4-2):1−52. (In Russ).]][Государственный реестр лекарственных средств [интернет]. Безопасность лекарственных препаратов. [State Register of Medicinal Products [Internet]. Bezopasnost’ lekarstvennykh preparatov. (In Russ).] Доступно по: http://www.grls.rosminzdrav.ru/Default.aspx. Ссылка активна на 05.12.2019.][Classification for drug related problems V8.02. Pharmaceutical Care Network Europe Foundation; 2003−2017 [cited 2018 May 10]. Available from: https://www.pcne.org/upload/files/230_PCNE_classification_V8-02.pdf.][Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation. 2011;123(23):2736–2747. doi: 10.1161/CIRCULATIONAHA.110.009449.][Cajfinger F, Debourdeau P, Lamblin A, et al. Low-molecular-weight heparins for cancer-associated thrombosis: adherence to clinical practice guidelines and patient perception in TROPIQUE, a 409-patient prospective observational study. Thromb Res. 2016;144:85−92. doi: 10.1016/j.thromres.2016.06.005.][Mahé I, Chidiac J, Helfer H, Noble S. Factors influencing adherence to clinical guidelines in the management of cancer-associated thrombosis. J Thromb Haemost. 2016;14(11):2107−2113. doi: 10.1111/jth.13483.][Sevestre MA, Belizna C, Durant C, et al. Compliance with recommendations of clinical practice in the management of venous thromboembolism in cancer: the CARMEN study. J Mal Vasc. 2014;39(3):161−168. doi: 10.1016/j.jmv.2014.03.001.][Browne C, Lanitis T, Hamilton M, et al. Impact of apixaban vs low molecular weight heparin /vitamin k antagonist on hospital resource use in patients with venous thromboembolism. J Med Econ. 2017;20(1):98−106. doi: 10.1080/13696998.2016.1258365.][Lanitis T, Leipold R, Hamilton M, et al. Cost-effectiveness of apixaban versus low molecular weight heparin/vitamin k antagonist for the treatment of venous thromboembolism and the prevention of recurrence. BMC Health Serv Res. 2017;17(1):74. doi: 10.1186/s12913-017-1995-8.][Diken AI, Yalçınkaya A, Hanedan MO, et al. Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: a cost analysis. Phlebology. 2018;33(1):53−59. doi: 10.1177/0268355516688358.]