Background and importance Pharmacological thromboprophylaxis reduces the risk of pulmonary embolism and deep vein thrombosis. Enoxaparin once a day is more relevant than unfractionated heparin (UFH) twice a day when glomerular filtration rate is >30 mL/min. The threefold alliance AVICENNE, as a real time clinical decision support system, works on the patient’s data, pharmaceutical algorithms (PA) and Pharmaclass (Keenturtle-F).

Aim and objectives To show the value of one AVICENNE algorithm in detecting UFH which was not indicated, and the acceptance by the physician of the switch to enoxaparin proposed by the pharmacist.

Material and methods A prospective study was carried out from March 2019 to September 2020 in two health facilities (1600 beds). One algorithm was encoded in Pharmaclass to detect patients with a UFH prescription and two glomerular filtration rate measurements >30 mL/min, the second higher than the first. A guideline detailed the pharmaceutical analysis, from history taking of detected DRPs to reporting of pharmaceutical interventions (PI). The first outcome was the number of detected DRPs and accepted PIs. The second outcome was the number of injections and hospital cost avoided.

Results The data were collected over 250 non-consecutive days. First, the pharmacist confirmed 98 DRPs after anamnesis and 96 PIs proposing the switch from UFH and enoxaparin. A total of 41 PIs (43%) were accepted by physicians. The secondary outcome included savings of 353 injections, providing a minimal cost saving of 1700€.

Conclusion and relevance AVICENNE optimises patients’ thromboprophylaxis management by triggering a pharmaceutical analysis on DRPs which are complex to detect. What is original is that this study showed that pharmaceutical analysis stayed relevant although the clinical and biological situation of the patient was improving.

Conflict of interest No conflict of interest