2026 Southeastern Residency Conference

Improving VTE Prophylaxis in Multiple Myeloma: An EHR-Based Approach Using IMPEDE and SAVED Risk Stratification
Score in an Outpatient Setting
Purpose:
Multiple myeloma patients are at an increased risk of venous thromboembolism due to drug usage, decreased mobility,
and hypercoagulability. Use of IMPEDE/SAVED score to determine prescribing of VTE prophylaxis has resulted in
significantly lower risk of venous thromboembolism. Real world data are needed to determine whether implementation
of a new electronic health record (EHR) system incorporating these scoring tools improves the effectiveness of guiding
thromboembolism prophylactic treatment in multiple myeloma patients, as clinical trial results may not fully reflect their
impact across diverse patient populations, practice settings, and workflow environments.
Methods:
This retrospective, single-center, quality improvement evaluated newly diagnosed patients with multiple myeloma (MM)
before and after implementation of IMPEDE and SAVED risk stratification score that was integrated in an EHR treatment
order set to guide prophylaxis selection. The pre-intervention group was managed using Varian EHR system, whereas the
post-intervention group used Cerner EHR platform, where the order set was implemented. Although the risk scores were
calculated by the treating physicians, integration of the order set serves as a structured reminder to promote consistent
risk assessment and documentation. The primary outcome was guideline adherence to VTE prophylaxis, with secondary
outcomes including incidence of VTE within six months of prophylaxis and assessing risk reclassification.
Results
A total of 19 patients with MM were included with 8 in the pre-intervention group using Varian EHR, and 11 patients in the
post-intervention group following Cerner EHR implementation with VTE prophylaxis order sets. Guideline adherence to
NCCN recommended VTE prophylaxis based on SAVED and IMPEDE scores were 87.5% and 25% pre-intervention versus
63.6% and 36.4% post-intervention, respectively. No patients receiving prophylactic anticoagulation developed VTE
within six months, and one pre-intervention patient (12.5%) had a prophylaxis change after crossover to the post
intervention period.
Conclusion
Implementation of IMPEDED and SAVED VTE risk stratification score being added to treatment order sets demonstrated
variable adherence to guideline recommended prophylaxis but was associated with no observed VTE events among
patients receiving prophylaxis. Larger studies are needed to further evaluate clinical impact and prescribing consistency