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Patient Adherence and Experience with Extended Use of Prophylactic Low-Molecular-Weight Heparin Following Pancreas and Liver Resection

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Guidelines recommend 28 days venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) following major abdominal surgery for cancer. Overall adherence with these recommendations is poor, but little is known about feasibility and tolerability from a patient perspective.

Methods

An institution-wide policy for routine administration of 28 days of post-operative LMWH following major hepatic or pancreatic resection for cancer was implemented in April 2013. Patients having surgery from July 2013 to June 2015 were approached to participate in an interview examining adherence and experience with extended duration LMWH.

Results

There were 100 patients included, with 81.4 % reporting perfect adherence with the regimen. The most frequent reasons for non-adherence were that a healthcare provider stopped the regimen or because of poor experience with injections. Most patients were able to correctly recall the reason for being prescribed LMWH (82.6 %), and 78.4 % of patients performed all injections themselves. Over half the patients (55.7 %) did not find the injections bothersome.

Conclusion

Patients reported high adherence and a manageable experience with post-operative extended-duration LMWH in an ambulatory setting following liver or pancreas resection. These findings suggest that patient adherence is not a major contributor to poor compliance with VTE prophylaxis guidelines.

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Acknowledgments

We would like to gratefully acknowledge Jessica Marchese and Jacqui van Warmerdam for conducting the patient interviews for this study. Part of this work was supported by an unrestricted grant from Sanofi.

Author Contributions

The study was designed by Lemke, Hallet, and Karanicolas and all the authors contributed to acquiring the data. Lemke performed the analysis, and all the authors contributed to interpreting the data. The manuscript was drafted by Lemke and critically revised by Beyfuss, Hallet, Coburn, Law, and Karanicolas. All the authors are accountable for all aspects of the work.

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Authors and Affiliations

  1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Madeline Lemke MD(c) MSc, Kaitlyn Beyfuss MSc(c), Natalie G. Coburn MD MPH FRCSC, Calvin H. L. Law MD MPH FRCSC & Paul J. Karanicolas MD PhD FRCSC

  2. Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, T2-016, Toronto, ON, M4N 3M5, Canada

    Madeline Lemke MD(c) MSc, Julie Hallet MD MSc FRCSC, Natalie G. Coburn MD MPH FRCSC, Calvin H. L. Law MD MPH FRCSC & Paul J. Karanicolas MD PhD FRCSC

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  1. Madeline Lemke MD(c) MSc
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  2. Kaitlyn Beyfuss MSc(c)
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  3. Julie Hallet MD MSc FRCSC
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  6. Paul J. Karanicolas MD PhD FRCSC
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Corresponding author

Correspondence to Paul J. Karanicolas MD PhD FRCSC.

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Conflicts of Interest

Dr. Karanicolas has been previously supported by Sanofi in the form of research grants and consulting fees.

Appendix. Feasibility and tolerability of post-discharge venous thromboembolism prophylaxis following hepatopancreaticobiliary surgery telephone interview script

Appendix. Feasibility and tolerability of post-discharge venous thromboembolism prophylaxis following hepatopancreaticobiliary surgery telephone interview script

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Lemke, M., Beyfuss, K., Hallet, J. et al. Patient Adherence and Experience with Extended Use of Prophylactic Low-Molecular-Weight Heparin Following Pancreas and Liver Resection. J Gastrointest Surg 20, 1986–1996 (2016). https://doi.org/10.1007/s11605-016-3274-0

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  • DOI: https://doi.org/10.1007/s11605-016-3274-0

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