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Factors associated with women’s adherence to postpartum thromboprophylaxis

  • Amihai Rottenstreich
  • Adi Karlin
  • Yosef KalishEmail author
  • Gabriel Levin
  • Misgav Rottenstreich
Article
  • 19 Downloads

Abstract

Postpartum low-molecular-weight heparin (LMWH) thromboprophylaxis is indicated for a substantial proportion of women. We assessed women’s adherence to postpartum thromboprophylaxis and the factors associated with adherence. This retrospective cohort study was conducted at a university hospital during 2018. Parturients for whom a recommendation for LMWH prophylaxis was given at discharge from the maternity ward were contacted at the end of the recommended post-discharge course of LMWH, and were invited to participate in a telephone survey. The main outcome measures were optimal (> 80%) and suboptimal adherence (< 80%) to LMWH administration, reasons for nonadherence, and views regarding LMWH, as assessed by an adapted Beliefs about Medication Questionnaire. Overall, 250 women completed the questionnaire. The median recommended duration of post-discharge LMWH was 7 [5–8] days. Suboptimal adherence was reported by 82 (32.8%); 45 (18.0%) women did not administer any LMWH dose following discharge and only 147 (58.8%) completed the full LMWH course. In multivariate analysis, patients’ perceptions of the necessity of LMWH [odds ratio (95% CI): 3.50 (2.12, 9.53), P = 0.002] and of the adequacy of the explanation given prior to discharge regarding LMWH technical administration [odds ratio (95% CI): 5.0 (2.33, 11.11), P < 0.001] were positively associated with optimal adherence. Nearly one-third of women prescribed postpartum LMWH thromboprophylaxis reported suboptimal adherence. Patients’ perceptions of the necessity of the treatment and their opinion of the adequacy of explanation regarding LMWH technical administration were identified as predictors of treatment compliance, and thus represent potential areas for improvement.

Keywords

Adherence Compliance Low-molecular weight heparin Postpartum thromboprophylaxis Venous thromboembolism 

Abbreviations

BMI

Body mass index

LMWH

Low-molecular weight heparin

VTE

Venous thromboembolism

Notes

Acknowledgements

Adi Karlin’s participation in this study was performed in fulfillment of the research requirements toward the MD degree. We would like to thank Ms. Cindy Cohen for her editorial assistance.

Authors contributions

AR, AK, MR, GL and YK reviewed the literature and wrote the paper. AK conducted the questionnaires. All authors read and approved the final manuscript as submitted.

Funding

No external funding was used in this conduct of this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the local institutional review board of Shaare Zedek Medical Center Helsinki Committee (IRB approval number: SZMC—0188-17, approved in 23 October 2017)

Supplementary material

11239_2019_1952_MOESM1_ESM.doc (66 kb)
Supplementary material 1 (DOC 66 kb)
11239_2019_1952_MOESM2_ESM.doc (35 kb)
Supplementary material 2 (DOC 35 kb)

References

  1. 1.
    Berg CJ, Callaghan WM, Syverson C, Henderson Z (2010) Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 116:1302–1309CrossRefGoogle Scholar
  2. 2.
    Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ 3rd (2005) Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 143:697–706CrossRefGoogle Scholar
  3. 3.
    Jacobsen AF, Skjeldestad FE, Sandset PM (2008) Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost 6:905–912CrossRefGoogle Scholar
  4. 4.
    Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO et al (2012) VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e691S–e736SCrossRefGoogle Scholar
  5. 5.
    ACOG (2018) Practice bulletin No. 196: thromboembolism in pregnancy. Obstet Gynecol 132(1):e1–e17CrossRefGoogle Scholar
  6. 6.
    Royal College of Obstetricians and Gynaecologists (2015). Green-top Guideline 37a: reducing the risk of thrombosis and embolism during pregnancy and the puerperium. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf. Accessed 18 Feb 2019
  7. 7.
    Chan WS, Rey E, Kent N, Society of Obstetricians & Gynaecologists of Canada (2014) Clinical practice guideline #308: venous thromboembolism and antithrombotic therapy in pregnancy. J Obstet Gynaecol Can 36:527–553CrossRefGoogle Scholar
  8. 8.
    Cutler DM, Everett W (2010) Thinking outside the pillbox—medication adherence as a priority for healthcare reform. N Engl J Med 362:1553–1555CrossRefGoogle Scholar
  9. 9.
    Horne R, Weinman J, Barber N, Elliott R, Morgan M. Concordance, adherence and compliance in medicine taking. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO), December 2005Google Scholar
  10. 10.
    Sanz E, Gomez-Lopez T, Martinez-Quintas MJ (2001) Perception of teratogenic risk of common medicines. Eur J Obstet Gynecol Reprod Biol 95:127–131CrossRefGoogle Scholar
  11. 11.
    Nordeng H, Ystrom E, Einarson A (2010) Perception of risk regarding the use of medications and other exposures during pregnancy. Eur J Clin Pharmacol 66:207–214CrossRefGoogle Scholar
  12. 12.
    Bonari L, Koren G, Einarson TR, Jasper JD, Taddio A, Einarson A (2005) Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counselling and determinants of decision making. Arch Womens Ment Health 8:214–220CrossRefGoogle Scholar
  13. 13.
    Centre for Maternal and Child Enquiries (2011) Savings Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–2008 The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG.  https://doi.org/10.1111/j.1471-0528.2010.02847.x Google Scholar
  14. 14.
    Hordern CE, Bircher CW, Prosser-Snelling EC, Fraser FK, Smith RP (2015) Patient compliance with postnatal thromboprophylaxis: an observational study. J Obstet Gynaecol 35(8):793–796CrossRefGoogle Scholar
  15. 15.
    Patel JP, Auyeung V, Patel RK, Marsh MS, Green B, Arya R et al (2012) Women’s views on and adherence to low-molecular-weight heparin therapy during pregnancy and the puerperium. J Thromb Haemost 10(12):2526–2534CrossRefGoogle Scholar
  16. 16.
    Guimicheva B, Patel JP, Roberts LN, Subramanian D, Arya R (2019) Women’s views, adherence and experience with postnatal thromboprophylaxis. Thromb Res 173:85–90CrossRefGoogle Scholar
  17. 17.
    Horne R, Weinman J, Hankins M (1999) The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health 14:1–24CrossRefGoogle Scholar
  18. 18.
    Clifford S, Barber N, Elliott R, Hartley E, Horne R (2006) Patient-centred advice is effective in improving adherence to medicines. Pharm World Sci 28:165–170CrossRefGoogle Scholar
  19. 19.
    Bauer KA (2013) Pros and cons of new oral anticoagulants. Hematol Am Soc Hematol Educ Program 2013:464–470CrossRefGoogle Scholar
  20. 20.
    Chan NC, Eikelboom JW, Weitz JI (2016) Evolving treatments for arterial and venous thrombosis: role of the direct oral anticoagulants. Circ Res 118(9):1409–1424CrossRefGoogle Scholar
  21. 21.
    Cohen H, Arachchillage DR, Middeldorp S, Beyer-Westendorf J, Abdul-Kadir R (2016) Management of direct oral anticoagulants in women of childbearing potential: guidance from the SSC of the ISTH. J Thromb Haemost 14(8):1673–1676CrossRefGoogle Scholar
  22. 22.
    Wiesen MH, Blaich C, Müller C, Streichert T, Pfister R, Michels G (2016) The direct factor Xa inhibitor rivaroxaban passes into human breast milk. Chest 150(1):e1–e4CrossRefGoogle Scholar
  23. 23.
    Israel Ministry of Health Clinical Trials. https://my.health.gov.il/CliniTrials/Pages/MOH_2018-05-23_000472.aspx. Accessed: 18 Feb 2019
  24. 24.
    Zhao Y, Ding A, Arya R, Patel JP (2018) Factors influencing the recruitment of lactating women in a clinical trial involving direct oral anticoagulants: a qualitative study. Int J Clin Pharm 40(6):1511–1518CrossRefGoogle Scholar
  25. 25.
    Greer IA, Hunt BJ (2005) Low molecular weight heparin in pregnancy: current issues. Br J Haematol 128:593–601CrossRefGoogle Scholar
  26. 26.
    Revell BJ, Smith RP (2010) Thrombosis and embolism in pregnancy and the puerperium, reducing the risk: what proportion of patients reach the threshold for thromboprophylaxis? Obstet Med 4:12–14CrossRefGoogle Scholar
  27. 27.
    Louis SG, Sato M, Geraci T, Anderson R, Cho SD, Van PY, Barton JS, Riha GM, Underwood S, Differding J, Watters JM, Schreiber MA (2014) Correlation of missed doses of enoxaparin with increased incidence of deep vein thrombosis in trauma and general surgery patients. JAMA Surg 149(4):365–370CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyHadassah-Hebrew University Medical CenterJerusalemIsrael
  2. 2.Faculty of MedicineHadassah-Hebrew University Medical CenterJerusalemIsrael
  3. 3.Department of HematologyHadassah-Hebrew University Medical CenterJerusalemIsrael
  4. 4.Department of Obstetrics and GynecologyShaare Zedek Medical CenterJerusalemIsrael

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