PMID- 30707246 OWN - NLM STAT- MEDLINE DCOM- 20191219 LR - 20200309 IS - 1432-1238 (Electronic) IS - 0342-4642 (Linking) VI - 45 IP - 2 DP - 2019 Feb TI - A multicentre controlled pre-post trial of an implementation science intervention to improve venous thromboembolism prophylaxis in critically ill patients. PG - 211-222 LID - 10.1007/s00134-019-05532-1 [doi] AB - PURPOSE: To test whether a multicomponent intervention would increase the use of low molecular weight heparin (LMWH) over unfractionated heparin (UFH) for venous thromboembolism (VTE) prophylaxis in critically ill patients and change patient outcomes and healthcare utilization. METHODS: Controlled pre-post trial of 12,342 adults admitted to 11 ICUs (five intervention, six control) May 1, 2015 to April 30, 2017 with no contraindication to pharmacological prophylaxis and an ICU stay longer than 24 h. Models were developed to examine temporal changes in ICU VTE prophylaxis (primary outcome), VTE, major bleeding, heparin-induced thrombocytopenia (HIT), death and hospital costs. RESULTS: The use of LMWH increased from 45.9% to 78.3% of patient days in the intervention group and from 37.9% to 53.3% in the control group, an absolute increase difference of 17.0% (32.4% vs. 15.4%, p = 0.001). Changes in the administration of UFH were inversely related to those of LMWH. There were no significant differences in the adjusted odds of VTE (ratio of odds ratios [rOR] 1.13, 95% CI 0.51-2.46) or major bleeding (rOR 1.22, 95% CI 0.97-1.54) post-implementation of the intervention (compared to pre-implementation) between the intervention group and the control group. HIT was uncommon in both groups (n = 20 patients). There were no significant changes for ICU and hospital mortality, length of stay and costs. Results were similar when stratified according to reason for ICU admission, patient weight and kidney function. CONCLUSIONS: A multicomponent intervention changed practice, but not clinical and economic outcomes. The benefit of implementing LMWH for VTE prophylaxis under real-world conditions is uncertain. FAU - Stelfox, Henry T AU - Stelfox HT AUID- ORCID: 0000-0003-1231-1490 AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. tstelfox@ucalgary.ca. AD - Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. tstelfox@ucalgary.ca. AD - Alberta Health Services, Calgary, Canada. tstelfox@ucalgary.ca. FAU - Brundin-Mather, Rebecca AU - Brundin-Mather R AD - W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada. FAU - Soo, Andrea AU - Soo A AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. AD - Alberta Health Services, Calgary, Canada. FAU - Parsons Leigh, Jeanna AU - Parsons Leigh J AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. AD - Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. FAU - Niven, Daniel J AU - Niven DJ AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. AD - Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. FAU - Fiest, Kirsten M AU - Fiest KM AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. AD - Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. FAU - Doig, Christopher James AU - Doig CJ AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. AD - Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. AD - Alberta Health Services, Calgary, Canada. FAU - Zuege, Danny J AU - Zuege DJ AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. AD - Alberta Health Services, Calgary, Canada. FAU - Kushner, Barry AU - Kushner B AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. AD - Alberta Health Services, Calgary, Canada. FAU - Clement, Fiona AU - Clement F AD - Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. FAU - Straus, Sharon E AU - Straus SE AD - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. FAU - Cook, Deborah J AU - Cook DJ AD - Deparment of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. FAU - Bagshaw, Sean M AU - Bagshaw SM AD - Department of Critical Care Medicine, Faculty of Medicine and Dentistry, and the School of Public Health, University of Alberta, Edmonton, AB, Canada. FAU - Sauro, Khara M AU - Sauro KM AD - Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. AD - Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. LA - eng GR - 20100368/Alberta Innovates - Health Solutions/International PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20190201 PL - United States TA - Intensive Care Med JT - Intensive care medicine JID - 7704851 RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) SB - IM CIN - Intensive Care Med. 2019 Feb;45(2):272-274. PMID: 30688997 MH - Aged MH - Anticoagulants/pharmacology/standards/therapeutic use MH - Critical Illness/therapy MH - Evidence-Based Practice/methods MH - Female MH - Heparin, Low-Molecular-Weight/pharmacology/*standards/therapeutic use MH - Humans MH - Implementation Science MH - Intensive Care Units/organization & administration/statistics & numerical data MH - Interrupted Time Series Analysis MH - Length of Stay/statistics & numerical data MH - Logistic Models MH - Male MH - Middle Aged MH - Odds Ratio MH - Outcome Assessment, Health Care/methods MH - Practice Patterns, Physicians' MH - Pre-Exposure Prophylaxis/methods/*standards MH - Registries/statistics & numerical data MH - Retrospective Studies MH - Venous Thromboembolism/drug therapy/*prevention & control OTO - NOTNLM OT - Critical care OT - Effectiveness OT - Heparin OT - Implementation science OT - Intensive care units OT - Venous thromboembolism EDAT- 2019/02/02 06:00 MHDA- 2019/12/20 06:00 CRDT- 2019/02/02 06:00 PHST- 2018/10/15 00:00 [received] PHST- 2019/01/14 00:00 [accepted] PHST- 2019/02/02 06:00 [pubmed] PHST- 2019/12/20 06:00 [medline] PHST- 2019/02/02 06:00 [entrez] AID - 10.1007/s00134-019-05532-1 [pii] AID - 10.1007/s00134-019-05532-1 [doi] PST - ppublish SO - Intensive Care Med. 2019 Feb;45(2):211-222. doi: 10.1007/s00134-019-05532-1. Epub 2019 Feb 1.