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Extended thromboprophylaxis for hip or knee arthroplasty. Does the administration route and dosage regimen affect adherence? A cohort study

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Abstract

Purpose

Prevention of thromboembolic disease requires patients’ adherence to the extended thromboprophylaxis scheme. Oral anticoagulants are expected to improve adherence as a result of their route of administration; however, this assumption is yet to be confirmed. The purpose of this study was to assess the impact of the route of administration and dosage regimen on the compliance to the prescription.

Materials and methods

This prospective cohort study included hip and knee arthroplasty patients who received pharmacological extended thromboprophylaxis with one daily injection, one daily oral tablet, or two daily oral tablets. A telephonic questionnaire was applied 35 days after the day of the surgery. Patients who omitted one or more doses of medication during the follow-up period were classified as “non-adherent.” Differences of adherence rates were assessed.

Results

Five hundred and twenty patients were included: 153 received Apixaban (oral, twice a day), 155 Enoxaparin (injectable, once a day), and 212 Rivaroxaban (oral, once a day). Patients receiving oral once a day medication was more compliant compared with those who received an oral medication twice a day. Non-adherence rates were 3.2 and 9.2%, respectively (p = 0.033). No significant differences (p = 0.360) were found between oral once a day and injectable once a day medication.

Conclusions

The number of daily doses prescribed was related to adherence to extended chemical prophylaxis, while the route of administration did not seem to have a significant impact. Strategies to promote outpatient compliance must be implemented, especially when regimes including more than one daily dose are prescribed.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 No. 117–15, Bogotá D. C., 110111186, Colombia

    Juan P. Moreno, Maria Bautista, Jorge Castro, Guillermo Bonilla & Adolfo Llinás

  2. School of Medicine, Universidad de Los Andes, Bogotá, Colombia

    Juan P. Moreno, Guillermo Bonilla & Adolfo Llinás

  3. School of Medicine, Universidad del Rosario, Bogota, Colombia

    Maria Bautista, Guillermo Bonilla & Adolfo Llinás

Authors
  1. Juan P. Moreno
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  2. Maria Bautista
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  3. Jorge Castro
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  4. Guillermo Bonilla
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  5. Adolfo Llinás
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Corresponding author

Correspondence to Guillermo Bonilla.

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Conflict of interest

JM declares that he has no conflict of interest. MB has received royalties for research support from a company or supplier as a principal researcher from Grunenthal and DePuy Synthes (Orthopedics), and other financial support from Grunenthal and Abbott. JC declares that he has no conflict of interest. GB has participated as paid speaker for Boehringer-Ingelheim, Pfizer, Sanofi, and DePuy Synthes (Orthopedics); has received other financial support from DePuy Synthes (Orthopedics); and has received research support from a company or supplier as a principal researcher for Grunenthal and DePuy Synthes (Orthopedics), outside this work. AL has received royalties from Innomed, Novamed, and 3 M; has participated as paid speaker for Zimmer, Shire, Novonordisk, Novartis, DePuy Synthes (Orthopedics), Medtronic Bayer, and Procaps; has participated as paid consultant for Zimmer and Medtronic, outside this work.

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Moreno, J.P., Bautista, M., Castro, J. et al. Extended thromboprophylaxis for hip or knee arthroplasty. Does the administration route and dosage regimen affect adherence? A cohort study. International Orthopaedics (SICOT) 44, 237–243 (2020). https://doi.org/10.1007/s00264-019-04454-3

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  • DOI: https://doi.org/10.1007/s00264-019-04454-3

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