Subscribe to RSS
DOI: 10.1160/TH11-07-0464
Post-discharge compliance to venous thromboembolism prophylaxis in high-risk orthopaedic surgery
Results from the ETHOS registry Financial support: The ETHOS study was sponsored by sanofi-aventis (Paris, France).Publication History
Received:
07 July 2011
Accepted after major revision:
01 November 2011
Publication Date:
29 November 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/201202/lookinside/thumbnails/10-1160-th11-07-0464-1.jpg)
Summary
Venous thromboembolism (VTE) risk persists for several weeks following high-risk orthopaedic surgery (HROS). The ETHOS registry evaluated post-operative VTE prophylaxis prescribed, and actual VTE prophylaxis received, compared with the 2004 American College of Chest Physicians (ACCP) guidelines in HROS patients. We performed a subanalysis of ETHOS to assess patient compliance with ACCP-adherent prophylaxis after discharge and the factors predicting poor compliance. Consecutive patients undergoing hip fracture surgery, total hip arthroplasty, or knee arthroplasty were enrolled at discharge from 161 centres in 17 European countries if they had received adequate in-hospital VTE prophylaxis. Data on prescribed and actual prophylaxis received were obtained from hospital charts and patient post-discharge diaries. Good compliance was defined as percentage treatment intake ≥80% with no more than two consecutive days without treatment. A total of 3,484 patients (79.4%) received ACCP-adherent anticoagulant prescription at discharge and 2,999 (86.0%) had an evaluable patient diary. In total, 87.7% of evaluable patients were compliant with prescribed treatment after discharge. The most common reason for non-compliance (33.4%) was “drug was not bought”. Injection of treatment was not a barrier to good compliance. Main factors affecting compliance related to purchase of and access to treatment, patient education, the person responsible for administering injections, country, and type of hospital ward at discharge. Within our study population, patient compliance with ACCP-adherent thromboprophylaxis prescribed at discharge was good. Improvements in patient education and prescribing practices at discharge may be important in further raising compliance levels in high-risk orthopaedic surgery patients.
Keywords
Compliance - ETHOS registry - orthopaedic surgery - post-discharge venous thromboembolism prophylaxis* Listed in Appendix.
-
References
- 1 Bergqvist D, Benoni G, Björgell O. et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med 1996; 335: 696-700.
- 2 Warwick D, Friedman RJ, Agnelli G. et al. Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry.. J Bone Joint Surg Br 2007; 89: 799-807.
- 3 Planes A, Vochelle N, Darmon JY. et al. Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet 1996; 348: 224-228.
- 4 Comp PC, Spiro TE, Friedman RJ. et al. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. Enoxaparin Clinical Trial Group. J Bone Joint Surg Am 2001; 83-A: 336-345.
- 5 Huo MH, Muntz J.. Extended thromboprophylaxis with low-molecular-weight heparins after hospital discharge in high-risk surgical and medical patients: a review. Clin Ther 2009; 31: 1129-1141.
- 6 Hull RD, Pineo GF, Stein PD. et al. Extended out-of-hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review.. Ann Intern Med 2001; 135: 858-869.
- 7 Geerts WH, Bergqvist D, Pineo GF. et al. American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl. 06) 381S-453S.
- 8 Loghman-Adham M.. Medication noncompliance in patients with chronic disease: issues in dialysis and renal transplantation. Am J Manag Care 2003; 9: 155-171.
- 9 Sackett DL, Haynes RB, Gibson ES. et al. Patient compliance with antihypertensive regimens. Patient Couns Health Educ 1978; 1: 18-21.
- 10 Rudd P.. Compliance with antihypertensive therapy: raising the bar of expectations. Am J Manag Care 1998; 4: 957-966.
- 11 Larsen J, Stovring H, Kragstrup J. et al. Can differences in medical drug compliance between European countries be explained by social factors: analyses based on data from the European Social Survey, round 2. BMC Public Health 2009; 9: 145.
- 12 Watts AC, Howie CR, Simpson AH.. Assessment of a self-administration protocol for extended subcutaneous thromboprophylaxis in lower limb arthroplasty. J Bone Joint Surg Br 2006; 88: 107-110.
- 13 Colwell Jr. CW, Pulido P, Hardwick ME. et al. Patient compliance with outpatient prophylaxis: an observational study.. Orthopedics 2005; 28: 143-147.
- 14 Geerts WH, Pineo GF, Heit JA. et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (Suppl. 03) 338S-400S.
- 15 Bergqvist D, Arcelus JI, Felicissimo P. Evaluation of duration of thromboembolic prophylaxis after major orthopedic surgery: the ETHOS registry. J Thromb Haemost.. 2009 7. (Suppl 2): Abstract OC-TU-019.
- 16 Bergqvist D, Arcelus JI, Felicissimo P. ETHOS Investigators.. Evaluation of the duration of thromboembolic prophylaxis after high-risk orthopaedic surgery: The ETHOS observational study. Thromb Haemost 2012; 107: 270-279.
- 17 Karve S, Cleves MA, Helm M. et al. Good and poor adherence: optimal cut-point for adherence measures using administrative claims data.. Curr Med Res Opin 2009; 25: 2303-2310.
- 18 Horne R, Cooper V, Fisher M.. Initiation of therapy with a subcutaneously administered antiretroviral in treatment-experienced HIV-infected patients: understanding physician and patient perspectives. AIDS Care 2008; 20: 1029-1038.
- 19 Horne R, Kovacs C, Katlama C. et al. Prescribing and using self-injectable anti-retrovirals: how concordant are physician and patient perspectives?. AIDS Res Ther 2009; 6: 2.
- 20 Guijarro R, Montes J, San Román C. et al. Venous thromboembolism and bleeding after total knee and hip arthroplasty. Findings from the Spanish National Discharge Database. Thromb Haemost 2011; 105: 610-615.
- 21 Arnsten JH, Gelfand JM, Singer DE.. Determinants of compliance with anticoagulation: A case-control study. Am J Med 1997; 103: 11-17.
- 22 Kulkarni SP, Alexander KP, Lytle B. et al. Long-term adherence with cardiovascular drug regimens.. Am Heart J 2006; 151: 185-191.
- 23 Herlitz J, Tóth PP, Naesdal J.. Low-dose aspirin therapy for cardiovascular prevention: quantification and consequences of poor compliance or discontinuation. Am J Cardiovasc Drugs 2010; 10: 125-141.
- 24 Platt AB, Localio AR, Brensinger CM. et al. Risk factors for nonadherence to warfarin: results from the IN-RANGE study. Pharmacoepidemiol Drug Saf. 2008; 17: 853-860.