Implementation of a clinical decision support tool to improve the adequate prescription of low-molecular-weight heparins in non-surgical patients

Froucke van Gosliga, Dagmar Pals, Annette van Ojik, Eric van Roon

Abstract

Non-surgical hospitalized patients have an increased risk of developing venous thromboembolism (VTE). This risk can be reduced by thromboprophylaxis with low-molecular-weight heparins (LMWHs), but adherence to thromboprophylaxis guidelines is generally low.

Introduction

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular diagnosis and a leading cause of increased healthcare costs and preventable death in hospitalized patients [1–3]. About 60% of all cases of VTE are hospital-acquired, occurring during or after a recent hospital admission [4].

Methods

This study was conducted at the Medical Centre Leeuwarden, a large teaching hospital in the Netherlands. The study has a prospective time series design with data collected at different time points pre- and post-intervention.

Results

In total 400 patients were included: 200 pre- and 200 post-intervention. Patient characteristics are shown in Table 2. There was no difference between patient characteristics before and after the implementation of the intervention, with the exception of the distribution across the different departments.

Discussion

The implementation of a clinical decision support (CDS) tool integrated into the electronic health record (EHR) was associated with an increase in the percentage of adequately prescribed low-molecular-weight heparin (LMWH) thromboprophylaxis in non-surgical patients at high risk of venous thromboembolism (VTE).

Conclusion

Our CDS tool integrated in the EHR may increase the percentage of high-risk patients adequately treated with thromboprophylaxis. With increasing amounts of data available in electronic health records, fine-tuned CDS tools might be an efficient and sustainable intervention to improve healthcare quality without interrupting workflow.

Citation: van Gosliga F, Pals D, van Ojik A, van Roon E (2026) Implementation of a clinical decision support tool to improve the adequate prescription of low-molecular-weight heparins in non-surgical patients. PLoS One 21(6): e0350017. https://doi.org/10.1371/journal.pone.0350017

Editor: Tomohiko Ai, Tokyo Women’s Medical University: Tokyo Joshi Ika Daigaku, JAPAN

Received: November 5, 2025; Accepted: May 6, 2026; Published: June 8, 2026

Copyright: © 2026 van Gosliga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information file.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.