Post-operative use of Low Molecular Weight Heparin: Are patients doing their bit?

Abstract

Introduction: Current National Institute for Health and Care Excellence (NICE) guidelines recommend the use of Low Molecular Weight Heparin (LMWH) for one month post-operatively in abdominal and pelvic cancer surgery to reduce risk of venous thromboembolism. We audited the prescription of LMWH at discharge and the compliance of patients with LMWH post-operatively and instigated measures to improve compliance. Materials and Methods: All patients undergoing major urological surgery from November 2011 to April 2012 were audited, with data collected on evidence of post-operative prescription (from discharge summaries). Patients within this 3-month period were questioned regarding compliance following discharge. Following this, changes were instigated to improve compliance (earlier discussion of post-operative LMWH administration in clinic, improved patient and junior doctor education). All patients undergoing surgery from November 2012 to June 2013 were identified and a re-audit completed. Results: Post-operative prescription of LMWH improved overall from 73% to 88%. Patient compliance to complete LMWH course improved from 23% to 88%. At re-audit, 97% of patients felt that training was adequate, and 94% of patients understood the rationale for taking LMWH at re-audit. Conclusion: Education of junior doctors improved prescription of LMWH at discharge. Improved patient education improves community LMWH use compliance post-discharge.

Outcomes from a prospectively implemented protocol using apixaban after robot‐assisted radical cystectomy

“…Hardy et al. [29] found that 77% of patients who were prescribed postoperative LMWH after major urological surgery failed to complete the course following discharge. Over 20% of urological oncologists cite poor patient compliance as a barrier to enoxaparin use for extended VTE prophylaxis, due to factors such as difficulty and pain with injection [15,28].…”

“…As enoxaparin requires daily self-injection, the issue of patient adherence remains an important factor to consider when deciding between enoxaparin and apixaban, which is taken orally. Hardy et al [29] found that 77% of patients who were prescribed postoperative LMWH after major urological surgery failed to complete the course following discharge. Over 20% of urological oncologists cite poor patient compliance as a barrier to enoxaparin use for extended VTE prophylaxis, due to factors such as difficulty and pain with injection [15,28].…”

Prevention of hospital-acquired thrombosis from a primary care perspective: a qualitative study

“…Previous work has demonstrated the positive impact of a simple educational intervention for raising patient awareness on prophylaxis adherence following urology surgery. 18 Piloting a similar intervention across a range of sites, involving a broader range of at-risk patient groups, should be considered.…”

“… 15 , 16 There is some evidence of similar issues of adherence among patients in the UK, 17 with some reporting adherence to LMWHs as low as 23%. 18 The guidelines also stipulate a supporting role for GPs, based on their notification of when patients are discharged and the prophylaxis prescribed. This type of communication between care settings is known to be problematic, 19 – 23 leaving patients vulnerable to adverse events following discharge, 24 – 29 and the role performed by primary care being unclear.…”