Factors associated with women’s adherence to postpartum thromboprophylaxis

  • Amihai Rottenstreich
  • Adi Karlin
  • Yosef KalishEmail author
  • Gabriel Levin
  • Misgav Rottenstreich


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.


Adherence Compliance Low-molecular weight heparin Postpartum thromboprophylaxis Venous thromboembolism 



Body mass index


Low-molecular weight heparin


Venous thromboembolism



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.


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

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Supplementary material 1 (DOC 66 kb)
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Supplementary material 2 (DOC 35 kb)


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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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