Patient compliance with venous thromboembolism prophylaxis (VTE)

Abstract

Venous thromboembolic disease (VTE) comprises pulmonary embolism (PE) and deep vein thrombosis (DVT), and causes morbidity and mortality, particularly in trauma and orthopaedic patients. Prevalence of 0.9% and 1.2% respectively are reported, with mortality rates up to 13.8%. Chemical thromboprophylactic agents including low molecular weight heparin (LMWH) are considered cost effective in reducing VTE risk. Evidence for anti-platelets including Aspirin for VTE prophylaxis is less compelling and is not supported as monotherapy. There has been no published data on patient compliance with LMWH in trauma outpatients. We aimed to determine whether trauma outpatients accept LMWH after discussing their VTE risk and the evidence for prophylaxis. For those accepting prophylaxis, we also investigated their compliance for the duration of immobilisation. Lower limb injured patients treated with external immobilisation over a 6 month period at our major trauma centre were included. On completion of immobilisation, they were requested to complete a 17-point questionnaire. Patients declining injectable subcutaneous LMWH as prophylaxis were offered Aspirin 75 mg as a second line agent. Seventy-five questionnaires were completed and five were excluded. Nineteen patients required surgical intervention for their injury, 51 were managed non-operatively. Thirty-one patients accepted LMWH and 30 chose Aspirin as an alternative. Nine patients declined or were not commenced on prophylaxis. Nineteen reported no missed Aspirin doses and 25 reported no missed LMWH doses. No patients reported missed doses due to pain, side effects or cessation of treatment for another reason. The mean average pain score recorded on the VAS was 3.8. No patients in the study were diagnosed with a VTE. LMWH is a recognised chemical thromboprophylactic and is well tolerated by patients for VTE risk reduction in lower limb immobilised outpatients. With poor evidence supporting Aspirin as a solo prophylactic agent, our local policy has withdrawn Aspirin for this purpose.

Adherence to Inpatient Venous Thromboembolism Prophylaxis: A Single Institution’s Concurrent Review

“…18 In terms of VTE chemoprophylaxis, adherence with medication orders has been reported by pharmacy records as well as patient report. 19,20 Chemoprophylaxis is often the most straightforward modality to monitor in clinical practice. Because of the strict regulations surrounding administration of medications in the hospital setting and meticulous documentation of dosing and timing, identifying missed doses of medications is rather straightforward.…”

Post‐discharge patient‐reported non‐adherence to aspirin compared to enoxaparin for venous thromboembolism prophylaxis after hip or knee arthroplasty

“…[5][6][7][8] There have been no published studies comparing non-adherence to once-daily aspirin versus once-daily enoxaparin when used for VTE prophylaxis following THA or TKA. Previously published studies have either compared twice-daily aspirin to LMWH for orthopaedic trauma patients 9,10 or DOACs to LMWH following THA or TKA. 5,11 The reasons underlying non-adherence have also been poorly reported, with the exception of one study which found that the most common reasons for non-adherence to extended aspirin prophylaxis were a lack of patient belief that it was required for 6 weeks, uncertainty regarding the required prophylaxis duration and conflicting advice given by practitioners other than the treating surgeon.…”

Incidence of Deep Vein Thrombosis in Floating Knee

“…Deep vein thrombosis (DVT) is a major complication of lower limb fractures 1 that may incur in death risk, such as for leading to pulmonary thromboembolism. 2 DVT is directly related to high-energy trauma.…”