Assessment of Saudi Women’s Adherence and Experience with Venous Thromboembolism Prophylaxis after Cesarean Section Delivery Using Telemedicine Technology

Abstract

Background. Telemedicine technology is widely used especially after the COVID-19 pandemic. It can be used to give medical advice as well as follow up with the patients at home in the outpatient setting. Low molecular weight heparin, such as enoxaparin, decreases the risk of venous thromboembolism after cesarean delivery. Objective. assessing postcesarean women’s adherence and experience to enoxaparin thromboprophylaxis regimens in the outpatient setting via telephone calls. Methods. prospective cohort study was conducted in the Maternity and Children Hospital (MCH). Postcesarean women were interviewed at the postnatal ward in the MCH. The participants were followed up for 10 days of the delivery to assess their adherence to and experience with enoxaparin thromboprophylaxis. Suboptimal adherence was defined as the missing of one or more doses of enoxaparin. Results. 170 women participated in this study. The majority of them (78.8%) were fully adherent to enoxaparin while 21.2% missed at least one dose. The most-reported causes for suboptimal adherence were perceived lack of necessity (44.4%), forget to take the injection (30.6%), feeling of high load going to the primary care unit to take injection (27.8%), and fear of injection (11.1%). Conclusion. Telemedicine technology could be used to assess patients’ adherence. The study results showed that the majority of participants were fully adherent to postcesarean enoxaparin but more than 20% of the participants were suboptimal adherent. Proper patient education techniques could influence patients’ adherence and potentially decrease the risk of DVT in those populations.

Factors limiting women’s adherence to venous thromboembolism prophylaxis after cesarean section in the Gaza Strip: A cross-sectional study

“…In this regard, the Saudi study by Elmaghraby and colleagues examined a similar cohort of post-CS women and strictly defined inadequate adherence as missing one or more doses of LMWH, permitting further comparisons to be drawn. 10 Concerning the causes of inadequate adherence to VTE prophylaxis, the most reported reason in our cohort was the lack of perceived necessity to use LMWH (51.11%). The percentage is similar to the study by Rottenstreich, where 50.5% cited the same reason.…”

“…Rottenstreich, Hordern, and Elmaghraby reported self-injection rates of 82.9%, 54%, and 30%, respectively. [9][10][11] Rottenstreich and colleagues also found a positive correlation between the perception of adequate communication regarding the technical injection of LMWH and the rates of adequate adherence. 11 The low rates of self-injection in our cohort are likely related to the poor education and communication offered to patients.…”

“…For instance, Rottenstreich and colleagues reported a higher rate of adherence (67.2%), while Elmaghraby and colleagues found that optimal adherence was seen in (78.8%), and Hordern and colleagues reported an even higher percentage (83.3%). [9][10][11] However, abstract numbers should be interpreted with caution since those studies had different populations and varying definitions of adequate adherence. In this regard, the Saudi study by Elmaghraby and colleagues examined a similar cohort of post-CS women and strictly defined inadequate adherence as missing one or more doses of LMWH, permitting further comparisons to be drawn.…”

“…9 Meanwhile, a study from Saudi Arabia in 2022 reported a 78.8% rate of adherence to VTE prophylaxis after CS, while the percentage dropped to 67.2% in a third study. 10,11 Identifying the gaps in prescription, education, and barriers to patient compliance is essential to avoid potentially preventable VTE events and to formulate interventions and strategies that are appropriate to the local context. This study is the first to assess the prescription patterns and barriers to women's adherence to VTE prophylaxis after CS in the Gaza Strip.…”

“…9 Meanwhile, a study from Saudi Arabia in 2022 reported a 78.8% rate of adherence to VTE prophylaxis after CS, while the percentage dropped to 67.2% in a third study. 10,11…”