In October 2018, a recommendation on the management of venous thromboembolism in cancer patients was developed at ICESP-HCFMUSP and included rivaroxaban as a new anticoagulant. To raise awareness on the recommendation an extensive educational plan was organized and an introductory outpatient clinic was carried out to check patients eligibility to switch from enoxaparin to rivaroxaban. ‘Alô Enfermeiro'is a 24/7 institutional call center for patients, managed by nurses. In order to empower them and ensure they would be able to reply accordingly, their training was prioritized.

This study intends to present results of education actions carried out before and during the first three months of the recommendation and to show knowledge gaps on cancer associated thrombosis identified during the same period.

Healthcare professionals were trained presentially and with residual materials. Physicians and nurses of the transitory clinic were additionally trained on how to evaluate and educate patients on the new anticoagulant. A folder for patients was developed and locally approved before delivery. Knowledge gaps were identified by recordings of ‘Alô Enfermeiro'and opinion requests for the thrombosis and hemostasis team from October 22nd 2018 to January 31st 2019. Results were described.

From October 2018 to January 2019, 215 physicians, 363 nurses and 48 pharmacists of the institution were trained on the recommendation. All patients who had started rivaroxaban (around 500) received the educational folder. During the 3 months of the transitory clinic, 57/358 patients (16%) on rivaroxaban called ‘Alô Enfermeiro’, 27 (47%) with questions about the drug (management facing invasive procedures, laboratory tests and chemotherapy, duration of anticoagulation and bleeding). Fourteen inpatients were evaluated by the thrombosis and hemostasis team due to rivaroxaban (eligibility to switch from enoxaparin, perioperative management, bleeding episodes and thrombosis recurrence). All requests could have been independently solved if physicians were more familiar to the recommendation.

Education was crucial to ensure a broad use of the recommendation. Knowledge gaps inspired a continuous educational program.