Abstract 312: Association of Electronic Health Record Documented Contraindications and Adverse Events in Patients Undergoing Peripheral Catheter Directed Thrombolysis

Background: Standardized documentation of contraindications for catheter-directed thrombolysis (CDT) and its association with adverse events (AEs) is unknown. We reviewed the presence of contraindications for CDT and their documentation in the EHR as part of a QI initiative.

Methods: We retrospectively reviewed 100 randomly selected patients who received CDT between 2015-2019. Data included demographics, comorbidities, and 10 established contraindications, and were classified as present, absent, or ambiguous (missing/unclear). AEs included bleeding, transfusion, urgent surgery, stroke, and in-hospital death.

Results: Majority of patients were non-white males, mean age of 58.5 ± 13 years. There was ambiguous documentation of the contraindications in 95% (95 of 100) of the records (mean contraindications/record = 4, range 0-7). The most frequently documented contraindication was BP; the least frequently documented were CVA/TIA ≤ 2 months and brain aneurysm. Thirty-nine patients had an AE with 92% (36 of 39) experiencing a BARC 2-3c bleed. Of those with an adverse event, the documented contraindications included SBP ≥ 180 mmHg, brain aneurysm, and platelets < 50,000 μL. Additional contraindications to CDT documented in patients who did not have an AE included DBP ≥ 110 mmHg, major surgery within 10 days, and neurosurgery within 3 months.

Conclusion: Contraindications for CDT lack clear documentation, and our rate of AEs is higher than expected. Also, some patients with contraindications still received CDT. This demonstrates the need for improvement in our screening process and has led to implementation of a standardized checklist prior to CDT initiation.