The computerized antithrombotic risk assessment tool (CARAT) marginally increased anticoagulation prescription in eligible patients at discharge compared to baseline (64.7% vs 57.8%, P = .35).
Observational
Yes
Does a computerized antithrombotic risk assessment tool improve the prescription of appropriate thromboprophylaxis in patients with nonvalvular atrial fibrillation?
A computerized decision-support tool for atrial fibrillation thromboprophylaxis recommended therapy changes in over half of patients but led to only a non-significant increase in actual anticoagulation prescriptions at discharge.
Absolute Event Rate: 64.7% vs 57.8%
p-value: p=.35
The computerized antithrombotic risk assessment tool (CARAT) is an online decision-support algorithm that facilitates a systematic review of a patient's stroke risk, bleeding risk, and pertinent medication safety considerations, to generate an individualized treatment recommendation. The CARAT was prospectively applied across 2 hospitals in the greater Sydney area. Its impact on antithrombotics utilization for thromboprophylaxis in patients with nonvalvular atrial fibrillation was evaluated. Factors influencing prescribers' treatment selection were identified. The CARAT recommended a change in baseline therapy for 51.8% of patients. Among anticoagulant-eligible patients (ie, where the risk of stroke outweighed the risk of bleeding) using "nil therapy" or antiplatelet therapy at baseline, the CARAT recommended an upgrade to warfarin in 60 (30.8%) patients. For those in whom the bleeding risk outweighed the stroke risk, the CARAT recommended a downgrade from warfarin to safer alternatives (eg, aspirin) in 37 (19%) patients. Among the "most eligible" (ie, high stroke risk, low bleeding risk, no contraindications; n = 75), the CARAT recommended warfarin for all cases. Discharge therapy observed a marginal increase in anticoagulation prescription in eligible patients (n = 116; 57.8% vs 64.7%, P = .35) compared to baseline. Predictors of warfarin use (vs antiplatelets) included congestive cardiac failure, diabetes mellitus, and polypharmacy. The CARAT was able to optimize the selection of therapy, increasing anticoagulant use among eligible patients. With the increasing complexity of decision-making, such tools may be useful adjuncts in therapy selection in atrial fibrillation. Future studies should explore the utility of such tools in selecting therapies from within an expanded treatment armamentarium comprising the non-vitamin K antagonist oral anticoagulants.
Pandya et al. (Mon,) conducted a observational in Nonvalvular atrial fibrillation. Computerized antithrombotic risk assessment tool (CARAT) vs. Baseline therapy was evaluated on Anticoagulation prescription in eligible patients at discharge (p=.35). The computerized antithrombotic risk assessment tool (CARAT) marginally increased anticoagulation prescription in eligible patients at discharge compared to baseline (64.7% vs 57.8%, P = .35).