Clinical Trial

European Journal of Clinical Pharmacology

, Volume 67, Issue 2, pp 109-120

First online:

Drug use problems with self-injected low-molecular-weight heparins in primary care

  • Seraina MengiardiAffiliated withPharmaceutical Care Research Group, Pharmacenter, University of Basel Email author 
  • , Dimitrios A. TsakirisAffiliated withDivision of Hematology, University Hospital Basel
  • , Markus L. LampertAffiliated withClinical Pharmacy, Kantonsspital Bruderholz
  • , Kurt E. HersbergerAffiliated withPharmaceutical Care Research Group, Pharmacenter, University of Basel

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Outpatient subcutaneous therapies are becoming increasingly common. A literature search failed to find produced any studies on application problems pertaining to the self-injection of low-molecular-weight heparins (LMWH) in a heterogeneous outpatient population under daily-life conditions. We therefore designed a study with the aim of recording drug use problems, patient satisfaction, compliance, problems arising from the injection site (abdomen vs. thigh), and residual drug volumes in pre-filled syringes used in self-injection therapy.


Patients were recruited in community pharmacies by 95 trained Master's students in pharmacy. Data were collected during recruitment and by means of structured questionnaire-based telephone interviews that were carried out at the beginning and the end of the LMWH treatment.


The median age of the 213 patients enrolled in the study was 54 years [interquartile range (IQR) 39–70 years]; of these, 15.5% had their injections administered by a third person. The rate of self-reported non-compliance was 17.1%. At least one relevant problem was recorded in 85.0% of the cases. At the end of the treatment, 38.9% of the patients stated self-administration of the injections required some effort. The preferred injection site was the thigh (68.5%). An overall mean residual drug volume ≥10.0% was detected for 3.9% of the patients. If residual drug was present, a median of 11.2% (IQR 8.6–17.6%) of the total drug volume had not been injected. Patients injecting into the thigh showed a higher risk of leaving residual medication (odds ratio 2.16, 95% confidence interval 1.04–4.51).


Most patients had drug use problems, whereas no clear factors were associated with non-compliance, the injection site (apart from residual drug), and discomfort or effort required (apart from prior injection use).


Low-molecular-weight heparin Outpatients Drug use problems Subcutaneous injections Injection site Community pharmacy