Women's views, adherence and experience with postnatal thromboprophylaxis

Abstract

IntroductionBased on current guidelines, many women qualify for postnatal thromboprophylaxis following childbirth, however, little information exists on how adherent women are and their experiences to both pharmacological and mechanical forms of thromboprophylaxis. Materials and MethodsWomen requiring postnatal thromboprophylaxis were given questionnaire packs exploring their beliefs about enoxaparin, anti-embolic stockings (AES) and intermittent pneumatic compression devices (IPCD). Women were also asked to complete a diary recording when doses of enoxaparin were injected, along with an estimation of the number of hours the AES were worn each day, if at all. Results were entered onto SPSS and analysed. ResultsSixty-seven women completed the questionnaire packs. Adherence to enoxaparin therapy was relatively high (82.4%). Women self-reported sub-optimal adherence levels to the AES, with 24% stating they never wore them once home. Reasons for this included being mobile, feeling hot and feeling as if they were cutting circulation off in the legs. Women reported a high level of acceptance of IPCD post caesarean section and would be happy for IPCD to be applied again in future deliveries, if required. ConclusionsAlthough many women are adherent to postnatal TP, our findings suggest that adherence to AES is sub-optimal following discharge from hospital and therefore their usefulness is questionable. Front-line clinical staff should discuss the importance of adherence to postnatal TP, in order to avert preventable venous thromboembolic events. Highlights ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T3  Adherence to postnatal thromboprophylaxis has been reported to be variable  Women's adherence to mechanical and pharmacological thromboprophylaxis was explored  Adherence to enoxaparin therapy was relatively high (82.4%). Adherence to stockings was low, with 24% of women stating they never wore them once home  Counsel women on the important role of thromboprophylaxis in preventing VTE

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

“…Our study showed an adherence rate of 78.8% among parturients' who underwent CS. This is consistent with previously published studies [ 11 , 14 , 15 , 21 ]. Considering the risk of VTEs following CS, this rate of adherence is reassuring [ 10 ].…”

“…Concerning the sample size, per our institution statistics, there are around 1000 C-section deliveries per year, with a power of 90%, and an adherence rate of 82% a sample of 138 participants would be needed. [ 11 ].…”

“…Examples of these risk factors are multiple pregnancies, obesity (BMI > 30 Kg/m2), advanced maternal age, and repeated cesarean section [ 5 – 7 ]. LMWH is given subcutaneously which may affect the parturients' adherence after hospital discharge [ 11 , 12 ]. Therefore, it is important to understand and assess postcesarean women's adherence to LMWH thromboprophylaxis regimens in the outpatient setting.…”

Intermittent pneumatic compression for venous thromboembolism prevention: a systematic review on factors affecting adherence

“…Research has demonstrated that using methods to systematically incorporate the user perspective early in the design process can result in the development of a device which is safe, effective and used by the patient. 44 Research more widely in the field that examined the use of a modern IPC device demonstrates that it is possible to develop comfortable devices 45 with 86% (26/30) of patients reporting it was comfortable and that they would use it again if required. Two studies 35 42 within this review reported adherence levels when studying different machine designs and one study focused on the length of IPC sleeve 30 and its effect on adherence with knee length sleeves being adhered to to a greater degree.…”

Preventing Postpartum Venous Thromboembolism in 2022: A Narrative Review

“…Unfortunately, as there are no clinical data to evaluate IPC in the postpartum period, the role of mechanical thromboprophylaxis in this setting is unclear. Also, one study pointed out a low adherence with compression stockings, after hospital discharge, highlighting its burden despite its safety ( 46 ).…”