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Patients’ experience and compliance with extended low molecular weight heparin prophylaxis post-surgery for gynecological cancer: a prospective observational study
  1. Zibi Marchocki1,2,
  2. Lucy Norris2,
  3. Sharon O'Toole2,
  4. Noreen Gleeson1,2 and
  5. Feras Abu Saadeh1,2
  1. 1 Department of Gynaecological Oncology, St. James's Hospital, Dublin, Ireland
  2. 2 Trinity College Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
  1. Correspondence to Dr Zibi Marchocki, Department of Gynaecological Oncology, St. James's Hospital, Dublin D03 VX82, Ireland; zmarchocki{at}gmail.com

Abstract

Objective Gynaecological cancer patients have a high risk of developing venous thromboembolism (VTE). There is limited information on patient experience and compliance with an extended low molecular weight heparin prophylaxis in this setting. The aim of this study was to assess patient compliance, satisfaction and experience with the extended low molecular weight heparin prophylaxis after major surgery for gynaecological cancer.

Methods This was a prospective observational study conducted in a large tertiary center for gynaecological cancer between July 2017-March 2018. Consecutive patients undergoing surgery for gynaecological cancer who received low molecular weight heparin prophylaxis for four weeks following surgery were recruited. All participants received a log book to record all injections, side effects, and questionnaire to be completed at the end of the study.

Results A total of 106 patients completed and returned the VTE prophylaxis logbook and questionnaire. Sixty-six (62%) patients received low molecular weight heparin for 28 days, twenty-five (24%) for 26-27 days, and 15 (14%) for less than 26 days. The median number of days of therapy was 28 days (range; 12-28 days). Reasons for missed or stopped injections included: forgetfulness(n=12), medical procedures (n=6), pain (n=5), incorrect prescription (n=4), patient choice (n=3), cost (n=2), physician request (n=2), non-availability of person administering the injections (n=1) or unknown (n=5). Sixty-one (58%) patients self-administered the injections. Patients who had the injection performed by a third person were twice as likely to experience pain compared to patients who self-administered (OR 2.81, p=0.003). Eighty-nine (84%) patients self-reported side effects during low molecular weight heparin prophylaxis including: bruising (75%), pain after injections (49%), itchiness (9%), swelling (9%) or other (8%). Although 83 (78%) patients were satisfied with injections, 91 (86%) admitted they would much prefer a tablet form.

Conclusions Compliance with standard recommended regimen of 28-days prophylaxis was completed by 62% of patients. Majority of patients (86%) reported a preference for a tablet form, if one was available.

  • thrombosis
  • cancer
  • low molecular weight heparin
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Footnotes

  • Contributors ZM: study concept and design, scientific conduct, data acquisition, data analysis and interpretation, drafting of the work and revising it critically for important intellectual content, final approval of the version to be published. LN: data interpretation, revising the work critically for important intellectual content, final approval of the version to be published. SO’T: revising the work critically for important intellectual content, final approval of the version to be published. NG: study concept and design, overlooking the study conduct, data interpretation, revising the work critically for important intellectual content, final approval of the version to be published. FAS: study concept and design, overlooking the study conduct, data interpretation, revising the work critically for important intellectual content, final approval of the version to be published.

  • Funding The study was partially funded by LEO Pharma Research Foundation. Grant Number: FASLN2916b.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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