TY - JOUR

T1 - Nonadherence in outpatient thrombosis prophylaxis with low molecular weight heparins after major orthopaedic surgery

AU - Wilke, Thomas

AU - Moock, Jörn

AU - Müller, Sabrina

AU - Pfannkuche, Matthias

AU - Kurth, Andreas

PY - 2010/9/1

Y1 - 2010/9/1

N2 - Background: According to some current guidelines, extended thromboprophylaxis after hip and knee arthroplasties is recommended. Outpatient prophylaxis with low molecular weight heparins (LMWH) is an important part of this prophylaxis, although the rates of adherence to these regimens is not known. Questions/purposes: We determined (1) the degree of nonadherence (NA) of patients with LMWH outpatient prophylaxis, and (2) whether specific independent factors explain NA. Methods: NA was determined by syringe count and by indirect and direct questions to patients. We defined six different NA indicators. To identify factors explaining LMWH NA, we used three different logistic regression models. Results: NA rates ranged between 13% and 21% depending on the indicator used for measurement. Patients who were nonadherent missed between 38% and 53% of their outpatient LMWH injections. If patients attended an outpatient rehabilitation program, the probability for their NA increased substantially. Moreover, the NA probability increased with each additional day between acute hospitalization and start of rehabilitation (linking days). NA was lower for patients who feared thrombosis or who believed antithrombotic drugs to be the most important measure in thromboprophylaxis. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

AB - Background: According to some current guidelines, extended thromboprophylaxis after hip and knee arthroplasties is recommended. Outpatient prophylaxis with low molecular weight heparins (LMWH) is an important part of this prophylaxis, although the rates of adherence to these regimens is not known. Questions/purposes: We determined (1) the degree of nonadherence (NA) of patients with LMWH outpatient prophylaxis, and (2) whether specific independent factors explain NA. Methods: NA was determined by syringe count and by indirect and direct questions to patients. We defined six different NA indicators. To identify factors explaining LMWH NA, we used three different logistic regression models. Results: NA rates ranged between 13% and 21% depending on the indicator used for measurement. Patients who were nonadherent missed between 38% and 53% of their outpatient LMWH injections. If patients attended an outpatient rehabilitation program, the probability for their NA increased substantially. Moreover, the NA probability increased with each additional day between acute hospitalization and start of rehabilitation (linking days). NA was lower for patients who feared thrombosis or who believed antithrombotic drugs to be the most important measure in thromboprophylaxis. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

KW - Health sciences

KW - Aged

KW - Ambulatory Care

KW - Arthroplasty, Replacement, Hip

KW - Arthroplasty, Replacement, Knee

KW - Female

KW - Fibrinolytic Agents

KW - Germany

KW - Health Knowledge, Attitudes, Practice

KW - Heparin, Low-Molecular-Weight

KW - Humans

KW - Injections

KW - Logistic Models

KW - Male

KW - Medication Adherence

KW - Questionnaires

KW - Risk Assessment

KW - Risk Factors

KW - Telephone

KW - Thrombosis

KW - Time Factors

KW - Treatment Outcome

UR - http://www.scopus.com/inward/record.url?scp=77955575162&partnerID=8YFLogxK

U2 - 10.1007/s11999-010-1306-8

DO - 10.1007/s11999-010-1306-8

M3 - Journal articles

C2 - 20333493

VL - 468

SP - 2437

EP - 2453

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

SN - 0009-921X

IS - 9

ER -