Thromboembolism in Arthroplasty: Compliance to Prophylaxis

Viana, Leandra Marla Aires Travassos; Nogueira, Iara Antônia Lustosa; Fontenele, Andréa Martins Melo; de Oliveira, Liszt Palmeira

doi:10.1055/s-0041-1731657

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Sumário

Original Article • Rev. bras. ortop. 56 (5) • Nov-Dec 2021 • https://doi.org/10.1055/s-0041-1731657 copy

Thromboembolism in Arthroplasty: Compliance to Prophylaxis^* * Study developed at the Hospital Universitário da Universidade Federal do Maranhão, São Luís, MA, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present paper aims to identify the proﬁle of compliance to thromboembolism drug prophylaxis in patients undergoing knee or hip arthroplasty at a public hospital.

Methods

This is a prospective cohort study, carried out from August 2017 to September 2018, with adult patients who were followed-up from admission until the postoperative period. The Morisky Medication Adherence Scale, consisting of eight items, was applied. Compliance was quantiﬁed according to the sum of all correct answers as high (8 points), medium (6 to < 8 points), and low compliance (< 6 points). For the present study, subjects with high compliance were referred as highly compliant, whereas those with medium to low compliance were referred as partially compliant.

Results

The compliance analysis showed that 73.0% of the patients were highly compliant and 27.0% were partially compliant to thromboprophylaxis. The anticoagulant prescribed at hospital discharge was rivaroxaban, a direct factor Xa inhibitor. Compliance was greater in patients who did not require reinforcement in prophylaxis guidance during follow-up; these subjects reported good and excellent acceptance of prophylaxis, although they were on multiple medications at discharge.

Conclusion

The data analysis allowed us to conclude that the factors that most inﬂuenced compliance were the levels of understanding and acceptance of prophylaxis by the patients, the amount of medication used per day by the subject, the cost of the anticoagulant agent, and its potential to cause adverse reactions.

Keywords
treatment adherence; anticoagulants; arthroplasty; prophylaxis; thromboembolism

Variables	Total		Compliance				p-value
	n = 70		Partially compliant patients		Highly compliant patients		p-value
	n	%	n	%	n	%
Age range (years old)
18 to 40	10	14.3	1	5.3	9	17.6	0.391
41 to 60	18	25.7	6	31.6	12	23.5
> 60	42	60.0	12	63.2	30	58.8
Gender
Male	23	32.9	3	15.8	20	39.2	0.063
Female	47	67.1	16	84.2	31	60.8	0.063
Schooling time (years)
0 to 4	31	44.3	10	52.6	21	41.2	0.627
5 to 8	19	27.1	5	26.3	14	27.5
> 8	20	28.6	4	21.1	16	31.4
Skin color (self-reported)
White	13	18.6	3	15.8	10	19.6	0.862
Black	8	11.4	3	15.8	5	9.8
Brown	47	67.1	13	68.4	34	66.7
Yellow	1	1.4	0	0.0	1	2.0
Not informed	1	1.4	0	0.0	1	2.0
Income (minimum wage)
up to 1	30	42.9	8	42.1	22	43.1	0.981
2 to 3	32	45.7	9	47.4	23	45.1
> 3	8	11.4	2	10.5	6	11.8
Means of transportation
Private	26	37.1	7	36.8	19	37.3	0.820
Public	38	54.3	11	57.9	27	52.9
Other	6	8.6	1	5.3	5	9.8
Occupation
Retired	45	64.3	12	63.2	33	64.7	0.759
Performs paid activity	17	24.3	4	21.1	13	25.5
Performs unpaid activity	8	11.4	3	15.8	5	9.8
Marital status
Lives with a partner	29	41.4	8	42.1	21	41.2	0.944
Lives without a partner	41	58.6	11	57.9	30	58.8	0.944
Place of origin
São Luís	40	57.1	8	42.1	32	62.7	0.272
Other location in Maranhão, Brazil	28	40.0	10	52.6	18	35.3
Another Brazilian State	2	2.9	1	5.3	1	2.0
Family composition
1 to 3 people	35	50.0	6	31.6	29	56.9	0.095
4 to 5 people	25	35.7	8	42.1	17	33.3
> 5 people	10	14.3	5	26.3	5	9.8

Variables	Total		Compliance				p-value
	n = 70		Partially compliant patients		Highly compliant patients		p-value
	n	%	n	%	n	%
Surgery type
Hip arthroplasty	60	85.7	17	89.5	43	84.3	0.583
Knee arthroplasty	10	14.3	2	10.5	8	15.7	0.583
Postoperative complications
No	62	88.6	14	82.4	46	90.2	0.385
Yes	8	11.4	3	17.6	5	9.8	0.385
Comorbidities (self-declared)
No	24	34.3	9	47.4	15	29.4	0.159
Yes	46	65.7	10	52.6	36	70.6	0.159
Number of medications used per day at discharge
1 to 4	20	28.6	9	50.0	11	21.6	0.022^*
≥ 5	49	70.0	9	50.0	40	78.4

Morisky	n	%
Do you sometimes forget to take your medication?
No	66	94.0
Yes	4	6.0
Thinking over the past 2 weeks, were there any days when you did not take your medication?
No	54	77.0
Yes	16	23.0
Have you ever cut back or stopped taking your medication without telling your doctor, because you felt worse when you took it?
No	65	93.0
Yes	5	7.0
When you travel or leave home, do you sometimes forget to bring along your medication?
No	67	96.0
Yes	3	4.0
Did you take your medication yesterday?
No	6	9.0
Yes	64	91.0
When you feel good, do you sometimes stop taking your medication?
No	68	97.0
Yes	2	3.0
Do you ever feel hassled about sticking to your treatment plan?
No	68	97.0
Yes	2	3.0
How often do you have difﬁculty remembering to take all your medications?
Never	59	84.0
Rarely	6	9.0
Sometimes	5	7.0
Usually	0	0
Always	0	0
Total score
8 (high compliance)	51	73.0
6 to < 8 (medium compliance)	10	14.0
< 6 (low compliance)	9	13.0
TOTAL	70	100.0

Reasons for noncompliance	n	%
Treatment abandonment or termination due to suspected adverse reaction to anticoagulant agent	6	8.6
Treatment abandonment or termination due to ﬁnancial reason	6	8.6
Treatment termination due to forgetfulness	4	5.7
Clinical complication with readmission	1	1.4
Communication issues	1	1.4
Treatment abandonment by own accord	1	1.4
TOTAL	19	27.1

Variables	Total		Compliance				p-value
	n = 70		Partially compliant patients		Highly compliant patients
	n	%	n	%	n	%
Knowledge on the purpose of the treatment
Yes	58	82.9	15	78.9	43	84.3	0.596
No	12	17.1	4	21.1	8	15.7
Knowledge on how to use ATC
Total lack of knowledge	3	4.3	1	5.3	2	3.9	0.059
Little knowledge	2	2.9	2	10.5	0	0
Good knowledge	65	92.9	16	84.2	49	96.1
Reported treatment acceptance
Excellent	27	38.6	4	21.1	23	45.1	0.010*
Good	38	54.3	11	57.9	27	52.9
Bad	5	7.1	4	21.1	1	2
Guidance requirement
Yes	18	25.7	11	57.9	7	13.7	0.000*
No	52	74.3	8	42.1	44	86.3

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Leandra Marla A. T. Viana, Mestre em Ciências da Saúde, Hospital Universitário da Universidade Federal do Maranhão, R. Barão de Itapari, 227 - Centro, São Luís - MA, 65020-070, Brasil (e-mail: leandra.viana@huufma.br).

Brasil

Brasil

Thromboembolism in Arthroplasty: Compliance to Prophylaxis* * Study developed at the Hospital Universitário da Universidade Federal do Maranhão, São Luís, MA, Brazil

Abstract

Objective

Methods

Results

Conclusion

Thromboembolism in Arthroplasty: Compliance to Prophylaxis^* * Study developed at the Hospital Universitário da Universidade Federal do Maranhão, São Luís, MA, Brazil