Patient compliance with postnatal thromboprophylaxis: An observational study

Abstract

Prescription of postnatal thromboprophylaxis has increased with the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence guidance. Our study of postnatal women meeting the criteria for thromboprophylaxis aimed to ascertain compliance with low-molecular-weight heparin and barriers to completion of a full course. Women were recruited from the antenatal clinic or postnatal wards. Those who agreed were contacted by telephone 14 days after delivery and asked about their compliance with and experience of thromboprophylaxis. 111 women were followed up. We found reported compliance with postnatal thromboprophylaxis to be high (83% taking the full course); most women self-injected (54%) but a significant number relied on family members (39%). Most would be prepared to take the course in a future pregnancy (94%); however, some felt that they needed more information. Reported compliance with postnatal thromboprophylaxis is high. This may be down to the motivation of the new mother, appropriate information giving and access to health care professionals for advice.

Women's views, adherence and experience with postnatal thromboprophylaxis

“…We found a relatively high self-reported adherence rate to pharmacological TP (82.4%). This is in line with previously reported studies in this population group [11][12] and suggests that when women are prescribed parenteral pharmacological TP, largely, they will adhere. In Patel and colleagues study, postnatal adherence to enoxaparin was reported at 93%, where the same women had also been prescribed antenatal TP [11].…”

“…We found no difference between perceived necessities and concerns in relation to mode of delivery or ethnicity. Horden and colleagues have also reported that women are highly accepting of postnatal TP [12]. In their study, 94.5% of women questioned indicated that they would accept TP in a future pregnancy.…”

“…In Patel and colleagues study, postnatal adherence to enoxaparin was reported at 93%, where the same women had also been prescribed antenatal TP [11]. In Horden and colleagues study of women prescribed just postnatal TP [12], adherence to the full course was reported at 83%. Interestingly, when we analysed adherence by duration of prescription, the women prescribed 6 weeks of postnatal enoxaparin were less adherent at 57% compared to 86% for the 7 day course (although not statistically significant).…”

“…In our study, we did not collect reasons for why doses of enoxaparin were missed. Common reasons reported in Horden's study for omission of doses or not completing the course of TP were bruising or wound complications, forgetting, a fear or dislike of needles and feeling that the injections were not helping [12].…”

“…Little information has been published in the literature on what women's views and experiences of postnatal thromboprophylaxis are and whether they actually adhere to what is recommended to them, particularly once discharged from hospital. The reports that do exist, suggest that adherence to postnatal TP is variable [11][12]. Indeed, Patel and colleagues work suggests in comparison to the antenatal period, postnatal adherence to LMWH is sub-optimal in some women, possibly due to their routine being disrupted by the new-born, and a perceived decrease in necessity, relative to the antenatal period [11].…”