Scolaris Content Display Scolaris Content Display

Вмешательства для использования тромбопрофилактики у госпитализированных пациентов с риском венозной тромбоэмболии

Appendices

Appendix 1. MEDLINE Ovid and Cochrane search strategy

1. exp Thrombosis/pc
2. exp Embolism/pc
3. (thrombosis or thrombotic or thrombus or thrombi or thromboembol*).tw.
4. (emboli* or embolus).tw.
6. clot?.tw.
7. (DVT or VTE or PE).tw.
8. or/1‐7
9. exp Anticoagulants/
10. anticoagulant*.tw.
11. (hydroxycoumarins or acenocoumarol or acenocoumar* or minisintrom or nicoumalone or s?nc?umar or sintrom or s?nthrom* or ancrod or ancrod or arvin or venacil or agkistrodon or arwinor or (blood adj3 coagulat* adj3 inhibit*) or "citric acid" or uralyt or dalteparin or tedelparin or fr‐860 or fr860 or dalteparin or kabi2165 or kabi‐2165 or fragmin* or "dermatan sulfate" or chondroitin or dextran or dextrans or hemodex or promit or macrodex or saviosol or rheodextran or polyglucin or hyskon or rheomacrodex or infukoll or rheopolyglucin or rheoisodex or rondex or dic?umarol or dicoumarin or bishydroxycoumarin or edetic or tetracemate or calcitetracemate or edta or ethylenedinitrilotetraacetic or edetate or (calcium adj3 tetacine) or versenate or coprin or edathamil or versene or dinitrilotetraacetate or "chelaton 3" or enoxaparin* or pk10169 or "pk 10169" or emt‐967 or emt96* or clexane or lovenox or emt‐966 or (ethyl adj3 biscoumacetate) or ethyldicoumarol or pelentan or tromexan or carbethoxydicoumarol or foy or gabexate or heparin* or at?eroid* or liquaemin or nadroparin* or fraxiparin* or cy‐216 or cy216 or "pentosan sulfuric polyester" or "pentosan sulphuric polyester" or ((polysulfate or polysulphate) adj sodium adj pentosan*) or ((sulfuric or sulphuric) adj polyester adj pentosan*) or fibrocid or ((hoe or bay or hoe‐bay) adj "946") or ((pentosan* or polypentose or xylan) adj (sulphate or sulfate or sp54 or sp‐54 or polysulfate* or polysulphate*)) or pz68 or pz‐68 or elmiron or hemoclar or phenindione or pindione or phenyline or fenilin or phenylindanedione or dindevan or phenprocoumon or falithrom or phenprogramma or phenprocoumalol or marcumar or phenylpropylhydroxycumarinum or phenprocoumarol or liquamar or marcoumar or "protein c" or "protein s" or warfarin marevan or coumadin* or warfant or aldocumar or tedicumar or "beta 2‐glycoprotein i" or apo‐h or anticardiolipin or "apoliprotein h" or ec‐vmfa or "endothelial cell viability maintaining factor" or "beta(2)gpi").tw.
12. exp Stockings, Compression/
13. exp Intermittent Pneumatic Compression Devices/
14. ((compression* or thromboembolism‐deterrent or anti‐embolism or TED) adj3 (stocking* or hose or hosiery or device*)).tw.
15. (prophylaxis or prophylactic).tw.
16. pc.fs.
17. (prevent* or reduce or reduction or diminish or decrease* or inhibit*).tw.
18. or/9‐17
19. exp Medical Order Entry Systems/
20. exp Reminder Systems/
21. exp Drug Therapy, Computer‐Assisted/
22. (("computeri?ed physician" or system) adj5 "order entry").tw.
23. CPOE.tw.
24. ((computeri?ed or automat* or medicat* or electronic*) adj5 (alert* or reminder*)).tw.
25. sticker?.tw.
26. prescription aid?.tw.
27. exp Decision Support Systems, Clinical/
28. decision support.tw.
29. CDS.tw.
30. e‐iatrogenesis.tw.
31. alert fatigue.tw.
32. electronic tool?.tw.
33. exp Guideline/
34. exp Guidelines as Topic/
35. exp Guideline Adherence/
36. exp Clinical Protocols/
37. protocol*.tw.
38. guideline*.tw.
39. adhere*.tw.
40. (comply or compliance).tw.
41. or/19‐40
42. exp Inpatients/ or exp Hospitalization/ or exp Hospitals/
43. (inpatient* or "in?patient*").tw.
44. exp Adolescent, Hospitalized/ or exp Child, Hospitalized/
45. (hospitali?e* or hospitali?ation).tw.
46. (admitted adj3 (hospital or patient*)).tw.
47. ("high risk" or "at risk").tw.
48. or/42‐47
49. thromboprophyla*.mp.
50. 8 and 18 and 41 and 48
51. 48 and 49
52. 50 or 51
53. limit 52 to yr="1980 ‐Current"

Appendix 2. Embase Ovid search strategy

1. exp thrombosis prevention/
2. exp embolism prevention/
3. (thrombosis or thrombotic or thrombus or thrombi or thromboembol*).tw.
4. (emboli* or embolus).tw.
5. (phlebothrombo* or phlebitis).tw.
6. exp blood clotting/
7. clot.tw.
8. (DVT or VTE or PE).ti,ab.
9. or/1‐8
10. exp *anticoagulant agent/
11. anticoagulant*.tw.
12. (hydroxycoumarins or acenocoumarol or acenocoumar* or minisintrom or nicoumalone or s?nc?umar or sintrom or s?nthrom* or ancrod or ancrod or arvin or venacil or agkistrodon or arwinor or (blood adj3 coagulat* adj3 inhibit*) or "citric acid" or uralyt or dalteparin or tedelparin or fr‐860 or fr860 or dalteparin or kabi2165 or kabi‐2165 or fragmin* or "dermatan sulfate" or chondroitin or dextran or dextrans or hemodex or promit or macrodex or saviosol or rheodextran or polyglucin or hyskon or rheomacrodex or infukoll or rheopolyglucin or rheoisodex or rondex or dic?umarol or dicoumarin or bishydroxycoumarin or edetic or tetracemate or calcitetracemate or edta or ethylenedinitrilotetraacetic or edetate or (calcium adj3 tetacine) or versenate or coprin or edathamil or versene or dinitrilotetraacetate or "chelaton 3" or enoxaparin* or pk10169 or "pk 10169" or emt‐967 or emt96* or clexane or lovenox or emt‐966 or (ethyl adj3 biscoumacetate) or ethyldicoumarol or pelentan or tromexan or carbethoxydicoumarol or foy or gabexate or heparin* or at?eroid* or liquaemin or nadroparin* or fraxiparin* or cy‐216 or cy216 or "pentosan sulfuric polyester" or "pentosan sulphuric polyester" or ((polysulfate or polysulphate) adj sodium adj pentosan*) or ((sulfuric or sulphuric) adj polyester adj pentosan*) or fibrocid or ((hoe or bay or hoe‐bay) adj "946") or ((pentosan* or polypentose or xylan) adj (sulphate or sulfate or sp54 or sp‐54 or polysulfate* or polysulphate*)) or pz68 or pz‐68 or elmiron or hemoclar or phenindione or pindione or phenyline or fenilin or phenylindanedione or dindevan or phenprocoumon or falithrom or phenprogramma or phenprocoumalol or marcumar or phenylpropylhydroxycumarinum or phenprocoumarol or liquamar or marcoumar or "protein c" or "protein s" or warfarin marevan or coumadin* or warfant or aldocumar or tedicumar or "beta 2‐glycoprotein i" or apo‐h or anticardiolipin or "apoliprotein h" or ec‐vmfa or "endothelial cell viability maintaining factor" or "beta(2)gpi").tw.
13. exp compression stocking/
14. ((compression* or thromboembolism‐deterrent or anti‐embolism or TED) adj3 (stocking* or hose or hosiery)).tw.
15. (prophylaxis or prophylactic).tw.
16. pc.fs.
17. (prevent* or reduce or reduction or diminish or decrease* or inhibit*).tw.
18. or/10‐17
19. exp hospital information system/
20. exp reminder system/
21. exp computer assisted drug therapy/
22. (("computeri?ed physician" or system) adj5 "order entry").tw.
23. CPOE.tw.
24. ((computeri?ed or automat* or medicat* or electronic*) adj5 (alert* or reminder*)).tw.
25. sticker*.tw.
26. prescription aid*.tw.
27. exp decision support system/
28. "decision support".tw.
29. CDS.tw.
30. e‐iatrogenesis.tw.
31. alert fatigue.tw.
32. electronic tool*.tw.
33. exp practice guideline/
34. exp clinical protocol/
35. (protocol* or guideline* or adhere*).tw.
36. (comply or compliance).tw.
37. or/19‐36
38. exp hospital patient/ or exp hospitalization/ or (*exp * hospital/ and exp patient/)
39. (inpatient* or "in?patient").tw.
40. (hospitali?e* or hospitali?ation).tw.
41. (admitted adj3 (hospital or patient*)).tw.
42. ("high risk" or "at risk").tw.
43. or/38‐42
44. thromboprophyla*.mp.
45. 9 and 18 and 37 and 43
46. 43 and 44
47. 45 or 46
48. limit 47 to yr="1980 ‐Current"

Appendix 3. BIOSIS previews Ovid search strategy

1. (thrombosis or thrombotic or thrombus or thrombi or thromboembol*).mp.
2. (emboli* or embolus).mp.
3. (phlebothrombo* or phlebitis).mp.
4. clot*.mp.
5. (DVT or VTE or PE).tw.
6. or/1‐5
7. anticoagulant*.mp.
8. (hydroxycoumarins or acenocoumarol or acenocoumar* or minisintrom or nicoumalone or s?nc?umar or sintrom or s?nthrom* or ancrod or ancrod or arvin or venacil or agkistrodon or arwinor or (blood adj3 coagulat* adj3 inhibit*) or "citric acid" or uralyt or dalteparin or tedelparin or fr‐860 or fr860 or dalteparin or kabi2165 or kabi‐2165 or fragmin* or "dermatan sulfate" or chondroitin or dextran or dextrans or hemodex or promit or macrodex or saviosol or rheodextran or polyglucin or hyskon or rheomacrodex or infukoll or rheopolyglucin or rheoisodex or rondex or dic?umarol or dicoumarin or bishydroxycoumarin or edetic or tetracemate or calcitetracemate or edta or ethylenedinitrilotetraacetic or edetate or (calcium adj3 tetacine) or versenate or coprin or edathamil or versene or dinitrilotetraacetate or "chelaton 3" or enoxaparin* or pk10169 or "pk 10169" or emt‐967 or emt96* or clexane or lovenox or emt‐966 or (ethyl adj3 biscoumacetate) or ethyldicoumarol or pelentan or tromexan or carbethoxydicoumarol or foy or gabexate or heparin* or at?eroid* or liquaemin or nadroparin* or fraxiparin* or cy‐216 or cy216 or "pentosan sulfuric polyester" or "pentosan sulphuric polyester" or ((polysulfate or polysulphate) adj sodium adj pentosan*) or ((sulfuric or sulphuric) adj polyester adj pentosan*) or fibrocid or ((hoe or bay or hoe‐bay) adj "946") or ((pentosan* or polypentose or xylan) adj (sulphate or sulfate or sp54 or sp‐54 or polysulfate* or polysulphate*)) or pz68 or pz‐68 or elmiron or hemoclar or phenindione or pindione or phenyline or fenilin or phenylindanedione or dindevan or phenprocoumon or falithrom or phenprogramma or phenprocoumalol or marcumar or phenylpropylhydroxycumarinum or phenprocoumarol or liquamar or marcoumar or "protein c" or "protein s" or warfarin marevan or coumadin* or warfant or aldocumar or tedicumar or "beta 2‐glycoprotein i" or apo‐h or anticardiolipin or "apoliprotein h" or ec‐vmfa or "endothelial cell viability maintaining factor" or "beta(2)gpi").tw.
9. ((compression* or thromboembolism‐deterrent or anti‐embolism or TED) adj3 (stocking* or hose or hosiery)).mp.
10. (prophylaxis or prophylactic).mp.
11. (prevent* or reduce or reduction or diminish or decrease* or inhibit*).mp.
12. or/7‐11
13. (("computeri?ed physician" or system) adj5 "order entry").tw.
14. CPOE.tw.
15. ((computeri?ed or automat* or medicat* or electronic*) adj5 (alert* or reminder*)).tw.
16. sticker*.tw.
17. prescription aid*.tw.
18. "decision support".tw.
19. CDS.tw.
20. e‐iatrogenesis.tw.
21. alert fatigue.tw.
22. electronic tool*.tw.
23. (guideline* or protocol* or adhere*).tw.
24. (comply or compliance).tw.
25. or/13‐24
26. (inpatient* or "in?patient").tw.
27. (hospitali?e* or hospitali?ation).tw.
28. (admit* adj3 (hospital or patient*)).tw.
29. ("high risk" or "at risk").tw.
30. or/26‐29
31. thromboprophyla*.mp.
32. 6 and 12 and 25 and 30
33. 30 and 31
34. 32 or 33

Appendix 4. CINAHL search strategy

S46 S44 OR S45
S45 S42 AND S43
S44 S8 AND S15 AND S32 AND S42
S43TI thromboprophyla* OR AB thromboprophyla*
S42 S33 OR S34 OR S35 OR S36 OR S37 OR S38 OR S39 OR S40 OR S41
S41TI ("high risk" OR "at risk") OR AB ("high risk" OR "at risk")
S40TI (admitted N3 (hospital or patient*)) OR AB (admitted N3 (hospital or patient*))
S39TI (hospitali?e* OR hospitali?ation) OR AB (hospitali?e* OR hospitali?ation)
S38(MH "Child, Hospitalized")
S37(MH "Adolescent, Hospitalized")
S36TI (inpatient* OR in?patient*) OR AB (inpatient* OR in?patient*)
S35(MH "Hospitals+")
S34(MH "Hospitalization+")
S33(MH "Inpatients")
S32 S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31
S31TI (protocol* or guideline* OR adhere*) OR AB (protocol* or guideline* OR adhere*)
S30(MH "Practice Guidelines")
S29TI electronic tool* OR AB electronic tool*
S28TI alert fatigue OR AB alert fatigue
S27TI e‐iatrogenesis OR AB e‐iatrogenesis
S26TI CDS OR AB CDS
S25TI decision support* OR AB decision support*
S24(MH "Decision Support Systems, Clinical")
S23TI prescription aid* OR AB prescription aid*
S22TI sticker* OR AB sticker*
S21TI ((computeri?ed or automat* or medicat* or electronic*) N5 (alert* or reminder*)) OR AB ((computeri?ed or automat* or medicat* or electronic*) N5 (alert* or reminder*))
S20TI CPOE OR AB CPOE
S19TI (("computeri?ed physician" or system) N5 "order entry") OR AB (("computeri?ed physician" or system) N5 "order entry")
S18(MH "Drug Therapy, Computer Assisted")
S17(MH "Reminder Systems")
S16(MH "Electronic Order Entry")
S15 S9 OR S10 OR S11 OR S12 OR S13 OR S14
S14TI (prevent* or reduce or reduction or diminish or decrease* or inhibit*) OR AB (prevent* or reduce or reduction or diminish or decrease* or inhibit*)
S13TI (prophylaxis or prophylactic) OR AB (prophylaxis or prophylactic)
S12TI ((compression* or thromboembolism‐deterrent or anti‐embolism or TED) N3 (stocking* or hose or hosiery or device*)) OR AB ((compression* or thromboembolism‐deterrent or anti‐embolism or TED) N3 (stocking* or hose or hosiery or device*))
S11(MH "Compression Garments")
S10TI anticoagulant* OR AB anticoagulant*
S9(MH "Anticoagulants+")
S8 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7
S7TX (DVT OR VTE OR PE) OR AB (DVT OR VTE OR PE)
S6TX (clot or clots) OR AB (clot or clots)
S5TX (phlebothrombo* or phlebitis) OR AB (phlebothrombo* or phlebitis)
S4TX (emboli* OR embolus) OR AB (emboli* or embolus)
S3TX (thrombosis or thrombotic or thrombus or thrombi or thromboembol*) OR AB (thrombosis or thrombotic or thrombus or thrombi or thromboembol*)
S2(MH "Embolism+/PC")
S1(MH "Thrombosis+/PC")

Appendix 5. WEB OF SCIENCE search strategy

#1 TS=(thrombosis or thrombotic or thrombus or thrombi or thromboembol* OR emboli* OR embolus OR phlebothrombo* or phlebitis OR clot OR DVT OR VTE OR PE)
#2 TS=(anticoagulant* OR hydroxycoumarins or acenocoumarol or acenocoumar* or minisintrom or nicoumalone or s?nc?umar or sintrom or s?nthrom* or ancrod or ancrod or arvin or venacil or agkistrodon or arwinor or (blood NEAR/3 coagulat* NEAR/3 inhibit*) or "citric acid" or uralyt or dalteparin or tedelparin or fr‐860 or fr860 or dalteparin or kabi2165 or kabi‐2165 or fragmin* or "dermatan sulfate" or chondroitin or dextran or dextrans or hemodex or promit or macrodex or saviosol or rheodextran or polyglucin or hyskon or rheomacrodex or infukoll or rheopolyglucin or rheoisodex or rondex or dic?umarol or dicoumarin or bishydroxycoumarin or edetic or tetracemate or calcitetracemate or edta or ethylenedinitrilotetraacetic or edetate or (calcium NEAR/3 tetacine) or versenate or coprin or edathamil or versene or dinitrilotetraacetate or "chelaton 3" or enoxaparin* or pk10169 or "pk 10169" or emt‐967 or emt96* or clexane or lovenox or emt‐966 or (ethyl NEAR/3 biscoumacetate) or ethyldicoumarol or pelentan or tromexan or carbethoxydicoumarol or foy or gabexate or heparin* or at?eroid* or liquaemin or nadroparin* or fraxiparin* or cy‐216 or cy216 or "pentosan sulfuric polyester" or "pentosan sulphuric polyester" or ((polysulfate or polysulphate) NEAR/1 sodium NEAR/1 pentosan*) or ((sulfuric or sulphuric) NEAR/1 polyester NEAR/1 pentosan*) or fibrocid or ((hoe or bay or hoe‐bay) NEAR/1 "946") or ((pentosan* or polypentose or xylan) NEAR/1 (sulphate or sulfate or sp54 or sp‐54 or polysulfate* or polysulphate*)) or pz68 or pz‐68 or elmiron or hemoclar or phenindione or pindione or phenyline or fenilin or phenylindanedione or dindevan or phenprocoumon or falithrom or phenprogramma or phenprocoumalol or marcumar or phenylpropylhydroxycumarinum or phenprocoumarol or liquamar or marcoumar or "protein c" or "protein s" or warfarin marevan or coumadin* or warfant or aldocumar or tedicumar or "beta 2‐glycoprotein i" or apo‐h or anticardiolipin or "apoliprotein h" or ec‐vmfa or "endothelial cell viability maintaining factor" or "beta(2)gpi" OR ((compression* or thromboembolism‐deterrent or anti‐embolism or TED) NEAR/3 (stocking* or hose or hosiery)) OR prophylaxis or prophylactic or prevent* or reduce or reduction or diminish or decrease* or inhibit*)
#3 TS=((("computeri?ed physician" or system) NEAR/5 "order entry") OR CPOE OR ((computeri?ed or automat* or medicat* or electronic*) NEAR/5 (alert* or reminder*)) or sticker* OR "prescription aid*" OR "decision support" OR CDS OR e‐iatrogenesis OR "alert fatigue" OR "electronic tool*" OR guideline* or protocol* OR adhere* OR comply or compliance)
#4 TS=(inpatient* OR "in‐patient*" or hospitali?e* or hospitali?ation or (admitted NEAR/3 (hospital* or patient*)) OR "high risk" or "at risk")
#5 TS=(thromboprophyla*)
#6 #4 AND #3 AND #2 AND #1
#7 #5 AND #4
#8 #7 OR #6

Appendix 6. LILACS Search Strategy

((thrombosis or thrombotic or thrombus or thrombi or thromboembol* or phlebothrombo* or phlebitis or clot* or DVT or VTE) AND (prophylaxis or prophylactic or prevent* or reduce or reduction or diminish or decrease* or inhibit*)) OR thromboprophyla*

Appendix 7. PubMed search strategy

#65,"Search #64 NOT medline[sb]"
#64,"Search #62 OR #63"
#63,"Search #60 AND #61"
#62,"Search #15 AND #27 AND #52 AND #60"
#61,"Search thromboprophyla*[tw]"
#60,"Search #52 OR #53 OR #54 OR #55 OR #56 OR #58 OR #59"
#59,"Search high risk[tw] or at risk[tw]"
#58,"Search admitted[tw] AND (hospital[tw] or patient[tw] or patients[tw])"
#56,"Search hospitalise*[tw] or hospitalisation[tw] or hospitalize*[tw] or hospitalization[tw]"
#55,"Search Adolescent, Hospitalized[Mesh] or Child, Hospitalized[Mesh]"
#54,"Search inpatient[tw] or inpatients[tw] or in‐patient[tw] or in‐patients[tw]"
#53,"Search Inpatients[Mesh] or Hospitalization[Mesh] or Hospitals[Mesh]"
#52,"Search #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46 OR #47 OR #48 OR #49 OR #50 OR #51"
#51,"Search comply[tw] or compliance[tw]"
#50,"Search adhere*[tw]"
#49,"Search guideline*[tw]"
#48,"Search protocol*[tw]"
#47,"Search Clinical Protocols[Mesh]"
#46,"Search Guideline Adherence[Mesh]"
#45,"Search Guidelines as Topic[Mesh]"
#44,"Search Guideine[Mesh] Schema: all"
#43,"Search Guideine[Mesh]"
#42,"Search electronic tool*[tw]"
#41,"Search alert fatigue[tw]"
#40,"Search e‐iatrogenesis[tw]"
#39,"Search CDS[tw]"
#38,"Search decision support[tw]"
#37,"Search ""Decision Support Systems, Clinical""[Mesh]"
#36,"Search prescription aid*[tw]"
#35,"Search sticker*[tw]"
#34,"Search ((computerised or computerized or automat* or medicat* or electronic*) AND (alert* or reminder*))[tw]"
#33,"Search CPOE[tw]"
#32,"Search ((""computerised physician"" or ""computerized physician"" or system) AND ""order entry"")[tw]"
#31,"Search ""Drug Therapy, Computer‐Assisted""[Mesh]"
#30,"Search ""Reminder Systems""[Mesh]"
#29,"Search ""Medical Order Entry Systems""[Mesh]"
#27,"Search #16 OR #17 OR #19 OR #21 OR #23 OR #24 OR #25 OR #26"
#26,"Search prevent*[tw] or reduce[tw] or reduction[tw] or diminish[tw] or decrease*[tw] or inhibit*[tw]"
#25,"Search prophylaxis[tw] or prophylactic[tw]"
#24,"Search ((compression* or thromboembolism‐deterrent or anti‐embolism or TED) AND (stocking* or hose or hosiery or device*))[tw]"
#23,"Search ""Intermittent Pneumatic Compression Devices""[Mesh]"
#21,"Search ""Stockings, Compression""[Mesh]"

#19,"Search hydroxycoumarins[tw] or acenocoumarol[tw] or acenocoumar*[tw] or minisintrom[tw] or nicoumalone[tw] or syncumar[tw] or sintrom[tw] or sinthrom*[tw] or synthrom*[tw] or ancrod[tw] or arvin[tw] or venacil[tw] or agkistrodon[tw] or arwinor[tw] or blood coagulation inhibitor[tw] or blood coagulation inhibitors[tw] or citric acid[tw] or uralyt[tw] or dalteparin[tw] or tedelparin[tw] or fr‐860[tw] or fr860[tw] or dalteparin[tw] or kabi2165[tw] or kabi‐2165[tw] or fragmin*[tw] or ""dermatan sulfate""[tw] or chondroitin[tw] or dextran[tw] or dextrans[tw] or hemodex[tw] or promit[tw] or macrodex[tw] or saviosol[tw] or rheodextran[tw] or polyglucin[tw] or hyskon[tw] or rheomacrodex[tw] or infukoll[tw] or rheopolyglucin[tw] or rheoisodex[tw] or rondex[tw] or dicumarol[tw] or dicoumarol[tw] or dicoumarin[tw] or bishydroxycoumarin[tw] or edetic[tw] or tetracemate[tw] or calcitetracemate[tw] or edta[tw] or ethylenedinitrilotetraacetic[tw] or edetate[tw] or (calcium AND tetacine)[tw] or versenate[tw] or coprin[tw] or edathamil[tw] or versene[tw] or dinitrilotetraacetate[tw] or ""chelaton 3""[tw] or enoxaparin*[tw] or pk10169[tw] or ""pk 10169""[tw] or emt‐967[tw] or emt96*[tw] or clexane[tw] or lovenox[tw] or emt‐966[tw] or ""ethyl biscoumacetate""[tw] or ethyldicoumarol[tw] or pelentan[tw] or tromexan[tw] or carbethoxydicoumarol[tw] or foy[tw] or gabexate[tw] or heparin*[tw] or ateroid*[tw] or atheroid*[tw] or liquaemin[tw] or nadroparin*[tw] or fraxiparin*[tw] or cy‐216[tw] or cy216[tw] or ""pentosan sulfuric polyester""[tw] or ""pentosan sulphuric polyester""[tw] or ((polysulfate or polysulphate) AND sodium AND pentosan*)[tw] or ((sulfuric or sulphuric) AND polyester AND pentosan*)[tw] or fibrocid[tw] or ((hoe or bay or hoe‐bay) AND ""946"")[tw] or ((pentosan* or polypentose or xylan)[tw] AND (sulphate or sulfate or sp54 or sp‐54 or polysulfate* or polysulphate*))[tw] or pz68[tw] or pz‐68[tw] or elmiron[tw] or hemoclar[tw] or phenindione[tw] or pindione[tw] or phenyline[tw] or fenilin[tw] or phenylindanedione[tw] or dindevan[tw] or phenprocoumon[tw] or falithrom[tw] or phenprogramma[tw] or phenprocoumalol[tw] or marcumar[tw] or phenylpropylhydroxycumarinum[tw] or phenprocoumarol[tw] or liquamar[tw] or marcoumar[tw] or ""protein c""[tw] or ""protein s""[tw] or ""warfarin marevan""[tw] or coumadin*[tw] or warfant[tw] or aldocumar[tw] or tedicumar[tw] or ""beta 2‐glycoprotein i""[tw] or apo‐h[tw] or anticardiolipin[tw] or ""apoliprotein h""[tw] or ec‐vmfa[tw] or ""endothelial cell viability maintaining factor""[tw] or ""beta(2)gpi""[tw]"

#17,"Search anticoagulant*[tw]"
#16,"Search ""Anticoagulants""[Mesh]"
#15,"Search #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #14"
#14,"Search DVT[tiab] OR VTE[tiab] OR PE[tiab]"
#12,"Search clot[tw]
#11,"Search phlebothrombo*[tw] or phlebitis[tw]"
#10,"Search emboli[tw] or embolus[tw]"
#9,"Search thrombosis[tw] or thrombotic[tw] or thrombus[tw] or thrombi[tw] or thromboembol*[tw]"
#8,"Search ""Embolism/prevention and control""[Mesh]"
#7,"Search ""Thrombosis/prevention and control""[Mesh]"

Appendix 8. Clinicaltrials.gov search strategy

thrombosis or thrombotic or thrombus or thrombi or thromboembol* or emboli* or embolus or phlebothrombo* or phlebitis or clot or clots or DVT or VTE or PE

Appendix 9. Funnel Plots

Figure 4; Figure 5; Figure 6; Figure 7; Figure 8

Appendix 10. Influence analysis

Influence analyses

Alerts ‐ Received prophylaxis

Study omitted

RD estimate without study

95% Confidence interval

Kucher 2005

0.21

0.06

0.36

Overhage 1996

0.22

0.16

0.28

Piazza 2009

0.19

0.16

0.22

Combined

0.21

0.15

0.27

Alerts ‐ Received appropriate prophylaxis

Study omitted

RD estimate without study

95% Confidence interval

Chapman 2011

0.16

0.12

0.21

Dexter 2001

0.14

0.06

0.22

Garcia 2009

0.16

0.12

0.20

Combined

0.16

0.12

0.20

Alerts ‐ Symptomatic VTE

Study omitted

RR estimate without study

95% Confidence interval

Chapman 2011

0.65

0.50

0.85

Kucher 2005

0.57

0.18

1.86

Piazza 2009

0.56

0.34

0.92

Combined

0.64

0.47

0.86

Multifaceted interventions ‐ Received prophylaxis (adjusted)

Study omitted

RD estimate without study

95% Confidence interval

Anderson 1994

0.04

0.01

0.06

Cavalcanti 2016

0.04

0.02

0.06

Labarere 2007

0.03

0.01

0.06

Pai 2013

0.04

0.02

0.06

Roy 2016

0.02

‐0.02

0.06

Combined

0.04

0.02

0.06

VTE: venous thromboembolism

Appendix 11. Abbreviations

CDSR: Cochrane Database of Systematic Rviews
CENTRAL: Cochrane Central Register of Controlled Trials
CI: confidence interval
CINAHL: Cumulative Index to Nursing and Allied Health Literature
CME: continuous medical education
Cochrane EPOC: Cochrane Effective Practice and Organisation of Care
CRT: cluster randomized controlled trial
DARE: Database of Abstracts of Reviews of Effects
DVT: deep vein thrombosis
GRADE: Grading of Recommendations Assessment, Development and Evaluation
I²: statistical index of heterogeneity
ICC: intraclass correlation
LILACS: Latin American and Caribbean health sciences LIterature
MeSH: Medical Subject Headings
NHS EED: NHS Economic Evaluation Database
PE: pulmonary embolism
PICOS: patients, intervention, comparator, outcome, setting
QA: quality assurance
QRT: quasi‐randomized controlled trial
RAP: received appropriate prophylaxis
RCT: randomized controlled trial
RD: risk difference
ROB: risk of bias
RP: received prophylaxis
RR: risk ratio
VTE: venous thromboembolism

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Summary of risk of bias: review authors’ judgements about each 'Risk of bias' item presented as percentages across all included studies
Figuras y tablas -
Figure 2

Summary of risk of bias: review authors’ judgements about each 'Risk of bias' item presented as percentages across all included studies

Summary of risk of bias: review authors’ judgements about each 'Risk of bias' item for each included study
Figuras y tablas -
Figure 3

Summary of risk of bias: review authors’ judgements about each 'Risk of bias' item for each included study

Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.1 Received prophylaxis.
Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.1 Received prophylaxis.

Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.2 Received appropriate prophylaxis.
Figuras y tablas -
Figure 5

Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.2 Received appropriate prophylaxis.

Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.3 Symptomatic VTE.
Figuras y tablas -
Figure 6

Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.3 Symptomatic VTE.

Funnel plot of comparison: 2 Multifaceted interventions versus standard care or another intervention, outcome: 2.1 Received prophylaxis (unadjusted).
Figuras y tablas -
Figure 7

Funnel plot of comparison: 2 Multifaceted interventions versus standard care or another intervention, outcome: 2.1 Received prophylaxis (unadjusted).

Funnel plot of comparison: 2 Multifaceted interventions versus standard care or another intervention, outcome: 2.2 Received prophylaxis (adjusted).
Figuras y tablas -
Figure 8

Funnel plot of comparison: 2 Multifaceted interventions versus standard care or another intervention, outcome: 2.2 Received prophylaxis (adjusted).

Comparison 1 Alerts versus standard care, Outcome 1 Received prophylaxis.
Figuras y tablas -
Analysis 1.1

Comparison 1 Alerts versus standard care, Outcome 1 Received prophylaxis.

Comparison 1 Alerts versus standard care, Outcome 2 Received appropriate prophylaxis.
Figuras y tablas -
Analysis 1.2

Comparison 1 Alerts versus standard care, Outcome 2 Received appropriate prophylaxis.

Comparison 1 Alerts versus standard care, Outcome 3 Symptomatic VTE.
Figuras y tablas -
Analysis 1.3

Comparison 1 Alerts versus standard care, Outcome 3 Symptomatic VTE.

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 1 Received prophylaxis (unadjusted).
Figuras y tablas -
Analysis 2.1

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 1 Received prophylaxis (unadjusted).

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 2 Received prophylaxis (adjusted).
Figuras y tablas -
Analysis 2.2

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 2 Received prophylaxis (adjusted).

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 3 Received prophylaxis (adjusted) sensitivity analysis: applied lowest ICC from other trials.
Figuras y tablas -
Analysis 2.3

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 3 Received prophylaxis (adjusted) sensitivity analysis: applied lowest ICC from other trials.

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 4 Received prophylaxis (adjusted) sensitivity analysis: applied mean ICC from other trials.
Figuras y tablas -
Analysis 2.4

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 4 Received prophylaxis (adjusted) sensitivity analysis: applied mean ICC from other trials.

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 5 Received prophylaxis (adjusted) sensitivity analysis: applied highest ICC from trials.
Figuras y tablas -
Analysis 2.5

Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 5 Received prophylaxis (adjusted) sensitivity analysis: applied highest ICC from trials.

Summary of findings for the main comparison. Computer or human alerts interventions versus standard care

Computer or human alerts compared with standard care for VTE prophylaxis.

Patient or population: adult medical and surgical patients at risk for VTE

Settings: hospital

Intervention: automatic reminder systems, such as computer alerts or human alerts, designed to increase the implementation of thromboprophylaxis and/or decrease the incidence of symptomatic or asymptomatic VTE

Comparison: standard care (no intervention)

Outcomes

Illustrative comparative risks* (95% CI)

Measures of effect (RD, RR) (95% CI; I²)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk*

Corresponding risk

Control group

Intervention group

Received prophylaxis**

(Follow‐up: 3 months)

Study population

RD 0.21 (0.15 to 0.27; 75%)

5057
(3 studies)

⊕⊕⊝⊝
Low1

178 per 1000

390 per 1000
(335 to 454)

Low risk population

145 per 1000

318 per 1000
(273 to 370)

High risk population

357 per 1000

782 per 1000
(671 to 910)

Received appropriate prophylaxis**

(Follow‐up: 36 hours
to 18 months)

Study population

RD 0.16 (0.12 to 0.20; 0%)

1820
(3 studies)

⊕⊕⊕⊝
Moderate2

305 per 1000

460 per 1000
(305 to 616)

Low risk population

175 per 1000

249 per 1000
(175 to 354)

High risk population

663 per 1000

941 per 1000
(663 to 1000)

Symptomatic VTE

(Follow‐up: 3 months)

Study population

RR 0.64 (0.47 to 0.86; 15%)

5353
(3 studies)

⊕⊕⊝⊝
Low3

56 per 1000

36 per 1000
(26 to 48)

Low risk population

29 per 1000

19 per 1000
(14 to 25)

High risk population

82 per 1000

52 per 1000
(39 to 71)

* Control risk was used as assumed risk (baseline risk), due to lack of well‐designed observational studies that measure this in detail to be presented as baseline risk for the population. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

** Clustered trials did not provide sufficient data (intraclass correlation (ICC) or adjusted confidence intervals) for us to pool cluster adjusted estimates.

CI: confidence interval; I²: statistical index of heterogeneity; RD: risk difference; RR: risk ratio; VTE: venous thromboembolism

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 We downgraded the level of certainty of evidence from high to low based on the following reasons: serious study limitations (quasi‐random sequence generation in 1/3 RCTs, no blinding of outcome assessment in 1/3 RCTs, selective reporting of safety outcomes in 1/3 RCTs. Random sequence generation, allocation concealment, blinding of participants and personnel, and other potential biases were unclear in most studies). No indirectness of evidence; some inconsistency of pooled results; no imprecision of pooled results; and undetected publication bias.

2 We downgraded the level of certainty of evidence from high to moderate based on the following reasons: serious study limitations (no blinding of participants and personnel in 2/3 RCTs, incorrect analysis that did not account for the clustered nature of the data in 1/3 RCTs. Random sequence generation, allocation concealment, blinding of outcome assessment, incomplete outcome data, selective reporting, and other potential biases were unclear in most studies). No indirectness of evidence; no inconsistency and imprecision of pooled RD results; and undetected publication bias.

3 We downgraded the level of certainty of evidence from high to low based on the following reasons: serious study limitations (quasi‐random sequence generation in 1/3 RCTs, selective reporting of safety outcomes in 1/3 RCTs. Random sequence generation, allocation concealment, blinding of participants and personnel, and other potential biases were unclear in most studies). No indirectness of evidence, no inconsistency of pooled RR results, some imprecision of pooled results related to the small number of events, and undetected publication bias.

Figuras y tablas -
Summary of findings for the main comparison. Computer or human alerts interventions versus standard care
Summary of findings 2. Multifaceted interventions versus standard care or another intervention

Multifaceted interventions compared with standard care or another type of intervention for VTE prophylaxis.

Patient or population: adult medical and surgical patients at risk for VTE

Settings: hospital

Intervention: multifaceted interventions (combination of interventions that may include education, audit and feedback, and alert), designed to trigger need for thromboprophylaxis

Comparison: standard care (no intervention) or another type of intervention*

Outcomes

Illustrative comparative risks** (95% CI)

Absolute effect (RD) (95% CI; I²)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk**

Corresponding risk

Control group

Intervention group

Received prophylaxis

(Unadjusted; Follow‐up: 2 to 4 months)

Study population

RD 0.03 (0.00 to 0.05; 64%)

26,330
(5 studies)

⊕⊕⊕⊝
Moderate1

Clustered trials did not provide sufficient data (intraclass correlation (ICC) or adjusted confidence intervals) for us to pool cluster‐adjusted estimates

Length of follow‐up was not specified in one study (Labarere 2007)

526 per 1000

558 per 1000
(526 to 594)

Low risk population

299 per 1000

317 per 1000
(299 to 338)

High risk population

803 per 1000

851 per 1000
(803 to 907)

Received prophylaxis

(Adjusted; Follow‐up: 2 to 4 months)

Study population

RD 0.04 (0.02 to 0.06; 0%)

9198
(5 studies)

⊕⊕⊕⊝
Moderate1

ICCs were available for 4/5 (Cavalcanti 2016 = 0.13, Labarere 2007 = 0.24, Pai 2013 = 0.022, Roy 2016 = 0.002) trials included in this meta‐analysis. ICC's were not available for Anderson 1994. Adjustment for the cluster design effect was performed via reported ICCs, no ICC was applied to the one trial that did not report an ICC (Anderson 1994)

Total patients are lower because cluster design effect applied to the numbers of events and participants.

Length of follow‐up was not specified in one study (Labarere 2007)

478 per 1000

507 per 1000
(488 to 531)

Low risk population

297 per 1000

315 per 1000
(303 to 330)

High risk population

804 per 1000

852 per 1000
(820 to 892)

* 'another type of intervention' was a multifaceted intervention targeted at different types of healthcare professionals (intervention targeted physicians and nurses; control targeted physicians only).

** Control risk was used as assumed risk (baseline risk), due to lack of well‐designed observational studies that measure this in detail to be presented as baseline risk for the population.The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; I²: Statistical index of heterogeneity; ICC: intraclass correlation; RCT: randomized controlled trial; RD: risk difference; VTE: venous thromboembolism

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 We downgraded the level of certainty of evidence from high to moderate based on the following reasons: serious study limitations (no blinding of participants and personnel in 4/5 RCTs, no blinding of outcome assessment in 2/5 RCTs, incomplete outcome data in 1/5 RCTs, selective reporting in 1/5 RCTs, baseline imbalances and incorrect analysis in 1/5 RCTs, and loss of clusters in 1/5 RCTs. Allocation concealment and selective reporting were unclear in most studies. No indirectness of evidence; no inconsistency and imprecision of pooled results; and undetected publication bias.

Figuras y tablas -
Summary of findings 2. Multifaceted interventions versus standard care or another intervention
Table 1. Quantitative risk of bias score for sensitivity analysis

Quantitative risk of bias score for sensitivity analysis

Trial

Summary ROB Score

Overall ROB

Anderson 1994

‐1

Unclear

Cavalcanti 2016

+1

Unclear

Chapman 2011

0

Unclear

Dexter 2001

0

Unclear

Fontaine 2006

0

Unclear

Garcia 2009

‐2

High

Hinchey 2010

‐4

High

Kucher 2005

+2

Low

Labarere 2007

0

Unclear

Overhage 1996

‐1

Unclear

Pai 2013

+1

Unclear

Piazza 2009

+3

Low

Roy 2016

+1

Unclear

ROB: risk of bias

Figuras y tablas -
Table 1. Quantitative risk of bias score for sensitivity analysis
Table 2. Primary outcome ‐ unadjusted/adjusted meta‐analysis and sensitivity analysis

Intervention

Outcome

Risk Difference (RD) (95% CI)

I² Statistic for RD

Relative Risk (RR) (95% CI)

Multifaceted unadjusted

Received prophylaxis

0.03 (0.00 to 0.05)

64%

1.07 (1.00 to 1.14)

Multifaceted adjusted

Received prophylaxis

0.04 (0.02 to 0.06)

0%

1.06 (1.02 to 1.11)

Multifaceted lowest ICC

Received prophylaxis

0.04 (0.02 to 0.06)

0%

1.06 (1.02 to 1.11)

Multifaceted mean ICC

Received prophylaxis

0.04 (0.01 to 0.06)

0%

1.06 (1.01 to 1.11)

Multifaceted highest ICC

Received prophylaxis

0.04 (0.01 to 0.06)

0%

1.06 (1.01 to 1.11)

ICCs were available for 4/5 (Cavalcanti 2016 = 0.13, Labarere 2007 = 0.24, Pai 2013 = 0.022, Roy 2016 = 0.002) trials included in this meta‐analysis. ICC's were not available for Anderson 1994.

In this table adjustment for the cluster design effect was performed via reported ICCs. No ICC was applied to the one trial that did not report an ICC (Anderson 1994). We performed a sensitivity analysis using the lowest reported ICC (0.002), the mean reported ICC (0.0985), and the highest reported ICC (0.24) for the trial that did not report an ICC (Anderson 1994). All trials in the meta‐analysis were clustered designs.

ICC: intracluster correlation

Anderson 1994; Cavalcanti 2016; Labarere 2007; Pai 2013; Roy 2016

Figuras y tablas -
Table 2. Primary outcome ‐ unadjusted/adjusted meta‐analysis and sensitivity analysis
Table 3. Alerts

Outcomes

Number of studies

Risk Difference (RD)

95% Confidence interval

Events, intervention

Events, control

Received prophylaxis

3

0.21

(0.15 to 0.27)

1003/2523

451/2534

Received appropriate prophylaxis

3

0.16

(0.12 to 0.20)

419/906

279/914

Venous thromboembolism outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Symptomatic VTE

3

0.64

(0.47 to 0.86)

94/2675

149/2678

Symptomatic DVT

2

0.43a

(0.23 to 0.78)

15/1255

35/1251

0.80b

(0.44 to 1.46)

19/1238

24/1255

Symptomatic PE

2

0.40a

(0.22 to 0.74)

14/1255

35/1251

0.63b

(0.21 to 1.93)

5/1238

8/1255

Asymptomatic VTE

Asymptomatic DVT

Asymptomatic PE

Mortality

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

All‐cause mortality

2

1.01a

(0.87 to 1.17)

282/1255

279/1251

1.04b

(0.88 to 1.24)

215/1238

209/1255

Sudden death

Safety outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Major bleeding

2

1.00a

(0.53 to 1.87)

19/1255

19/1251

0.91b

(0.53 to 1.54)

25/1238

28/1255

Minor bleeding

1

0.92a

(0.69 to 1.23)

81/1255

88/1251

Thrombocytopenia

aKucher 2005, bPiazza 2009

DVT: deep vein thrombosis
PE: pulmonary embolism
VTE: venous thromboembolism

Chapman 2011; Dexter 2001; Garcia 2009; Kucher 2005; Piazza 2009; Overhage 1996

Figuras y tablas -
Table 3. Alerts
Table 4. Computer alerts

Outcomes

Number of studies

Risk Difference (RD)

95% Confidence interval

Events, intervention

Events, control

Received prophylaxis

2

0.19a

(0.16 to 0.22)

421/1255

182/1251

0.08b

(‐0.17 to 0.33)

13/30

10/28

Received appropriate prophylaxis

1

0.17c

(0.12 to 0.21)

228/664

116/662

Venous thromboembolism outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Symptomatic VTE

1

0.59a

(0.43 to 0.80)

61/1255

103/1251

Symptomatic DVT

1

0.43a

(0.23 to 0.78)

15/1255

35/1251

Symptomatic PE

1

0.40a

(0.22 to 0.74)

14/1255

35/1251

Asymptomatic VTE

Asymptomatic DVT

Asymptomatic PE

Mortality

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

All‐cause mortality

1

1.01a

(0.87 to 1.17)

282/1255

279/1251

Sudden death

Safety outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Major bleeding

1

1.00a

(0.53 to 1.87)

19/1255

19/1251

Minor bleeding

1

0.92a

(0.69 to 1.23)

81/1255

88/1251

Thrombocytopenia

aKucher 2005; bOverhage 1996; cDexter 2001

DVT: deep vein thrombosis
PE: pulmonary embolism
VTE: venous thromboembolism

Dexter 2001; Kucher 2005; Overhage 1996

Figuras y tablas -
Table 4. Computer alerts
Table 5. Human alerts

Outcomes

Number of studies

Risk Difference (RD)

95% Confidence interval

Events, intervention

Events, control

Received prophylaxis

1

0.25a

(0.22 to 0.29)

569/1238

259/1255

Received appropriate prophylaxis

2

0.14b

(0.05 to 0.24)

147/182

114/172

0.12c

(‐0.03 to 0.28)

44/60

49/80

Venous thromboembolism outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Symptomatic VTE

2

0.79a

(0.50 to 1.25)

32/1238

41/1255

0.19b

(0.02 to 1.60)

1/182

5/172

Symptomatic DVT

1

0.80a

(0.44 to 1.46)

19/1238

24/1255

Symptomatic PE

1

0.63a

(0.21 to 1.93)

5/1238

8/1255

Asymptomatic VTE

Asymptomatic DVT

Asymptomatic PE

Mortality

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

All‐cause mortality

1

1.04a

(0.88 to 1.24)

215/1238

209/1255

Sudden death

Safety outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Major bleeding

1

0.91a

(0.53 to 1.54)

25/1238

28/1255

Minor bleeding

Thrombocytopenia

aPiazza 2009; bChapman 2011; cGarcia 2009

DVT: deep vein thrombosis
PE: pulmonary embolism
VTE: venous thromboembolism

Chapman 2011; Garcia 2009; Piazza 2009

Figuras y tablas -
Table 5. Human alerts
Table 6. Multifaceted interventions

Outcomes

Number of studies

Risk Difference (RD)

95% Confidence interval

Events, intervention

Events, control

Received prophylaxis

5

0.03

(0.00 to 0.05)

7306/13611

6509/12722

Received appropriate prophylaxis

2

0.03a

(‐0.00 to 0.06)

263/1154

290/1457

0.02b

(0.01 to 0.03)

1474/8359

1094/6992

Venous thromboembolism outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Symptomatic VTE

1

0.97b

(0.77 to 1.23)

150/8068

128/6692

Symptomatic DVT

1

 1.17b

(0.76 to 1.81)

48/8068

34/6692

Symptomatic PE

1

 0.71b

(0.44 to 1.15)

31/8068

36/6692

Asymptomatic VTE

Asymptomatic DVT

1

1.21c

(0.86 to 1.70)

49/315

64/497 

Asymptomatic PE

Mortality

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

All‐cause mortality

2

1.02b

(0.93 to 1.12)

940/8298

764/6884

0.95d

(0.88 to 1.01)

1096/3327

1196/3434

Sudden death

1

1.01b

(0.72 to 1.43)

72/8298

59/6884

Safety outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Major bleeding

1

0.96b

(0.72 to 1.28)

100/8068

86/6692

Minor bleeding

 ‐

Thrombocytopenia

1

0.53c

(0.02 to 12.86) 

0/315

1/497

aPai 2013; bRoy 2016; cLabarere 2007; dCavalcanti 2016

DVT: deep vein thrombosis
PE: pulmonary embolism
VTE: venous thromboembolism

Anderson 1994 CME + QA Group; Cavalcanti 2016; Hinchey 2010; Labarere 2007; Pai 2013; Roy 2016

Figuras y tablas -
Table 6. Multifaceted interventions
Table 7. Educational interventions

Outcomes

Number of studies

Risk Difference (RD)

95% Confidence interval

Events, intervention

Events, control

Received prophylaxis

1

‐0.02

(‐0.09 to 0.05)

252/513

175/342

Received appropriate prophylaxis

Venous thromboembolism outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Symptomatic VTE

Symptomatic DVT

Symptomatic PE

Asymptomatic DVT

Asymptomatic PE

Mortality

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

All‐cause mortality

Sudden death

Safety outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Major bleeding

Minor bleeding

Thrombocytopenia

Anderson 1994 CME group

DVT: deep vein thrombosis
PE: pulmonary embolism
VTE: venous thromboembolism

Figuras y tablas -
Table 7. Educational interventions
Table 8. Preprinted orders

Outcomes

Number of studies

Risk Difference (RD)

95% Confidence interval

Events, intervention

Events, control

Received prophylaxis

1

‐0.05

(‐0.12 to 0.02)

115/360

133/359

Received appropriate prophylaxis

Venous thromboembolism outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Symptomatic VTE

Symptomatic DVT

Symptomatic PE

Asymptomatic VTE

Asymptomatic DVT

Asymptomatic PE

Mortality

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

All‐cause mortality

Sudden death

Safety outcomes

Number of studies

Risk Ratio (RR)

95% Confidence interval

Events, intervention

Events, control

Major bleeding

Minor bleeding

Thrombocytopenia

Fontaine 2006

DVT: deep vein thrombosis
PE: pulmonary embolism
VTE: venous thromboembolism

Figuras y tablas -
Table 8. Preprinted orders
Comparison 1. Alerts versus standard care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Received prophylaxis Show forest plot

3

5057

Risk Difference (M‐H, Random, 95% CI)

0.21 [0.15, 0.27]

2 Received appropriate prophylaxis Show forest plot

3

1820

Risk Difference (M‐H, Random, 95% CI)

0.16 [0.12, 0.20]

3 Symptomatic VTE Show forest plot

3

5353

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.47, 0.86]

Figuras y tablas -
Comparison 1. Alerts versus standard care
Comparison 2. Multifaceted interventions versus standard care or another intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Received prophylaxis (unadjusted) Show forest plot

5

26330

Risk Difference (M‐H, Random, 95% CI)

0.03 [0.00, 0.05]

2 Received prophylaxis (adjusted) Show forest plot

5

9198

Risk Difference (M‐H, Random, 95% CI)

0.04 [0.02, 0.06]

3 Received prophylaxis (adjusted) sensitivity analysis: applied lowest ICC from other trials Show forest plot

5

9089

Risk Difference (M‐H, Random, 95% CI)

0.04 [0.02, 0.06]

4 Received prophylaxis (adjusted) sensitivity analysis: applied mean ICC from other trials Show forest plot

5

8491

Risk Difference (M‐H, Random, 95% CI)

0.03 [0.01, 0.06]

5 Received prophylaxis (adjusted) sensitivity analysis: applied highest ICC from trials Show forest plot

5

8440

Risk Difference (M‐H, Random, 95% CI)

0.04 [0.01, 0.06]

Figuras y tablas -
Comparison 2. Multifaceted interventions versus standard care or another intervention