MedWire News: Hospital patients are more likely to adhere to thromboprophylaxis if given once daily low molecular weight heparin (LMWH) than a twice or thrice daily course of unfractionated heparin (UFH), US study findings show.
The research, published in the American Journal of Medicine, also highlighted the high rate of missed or late doses of both forms of heparin due to patient refusal of treatment.
Samuel Goldhaber and co-workers, from Brigham and Women's Hospital in Boston, Massachusetts, comment: “Improved communication between providers and patients, as well as hospital-based patient education efforts are necessary to empower patients to participate in venous thromboembolism prevention, to improve adherence to recommended prophylactic regimens and, consequently, to prevent in-hospital deep vein thrombosis and pulmonary embolism.”
The team examined data from an electronic medication administration record for medical or surgical patients prescribed prophylactic LMWH (n=125) or UFH (n=125). Nurses were asked to document reasons for all doses that were given more than 1 hour before or after the scheduled time, or omitted entirely.
The ratio of doses given to doses prescribed was significantly higher for patients given LMWH than for patients given twice or thrice daily UFH, at 94.9% versus 87.8% and 86.8%, respectively.
LMWH-treated patients received all scheduled doses 77% of the time compared with 45% and 54% of the time for twice and thrice daily UFH-treated patients, respectively.
However, the reasons given for omitted doses did not significantly differ between the treatment groups, with patient refusal the most common cause for both LMWH (39%) and UFH (44%) regimens.
“Other” reasons – such as patient going into surgery or pending discharge from hospital – was the next most common reason for omitted doses, followed by treatment held by physician, and patient “off the floor”.
Commenting on these barriers to effective thromboprophylaxis, Goldhaber et al write: “Rapid movement of patients within the hospital for diagnostic tests and procedures and the emphasis on shortened hospital length of stay represent important challenges.”
They suggest: “Use of innovative strategies and new technologies such as personal digital assistants, “smart” phones, video surveillance, or electronic medication administration record software systems might improve patient monitoring and ensure timely dose delivery but will require additional effort and expense.”
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