Issues of Adherence to Thromboprophylaxis with Enoxaparin in Patients with Sickle Cell Disease
Thromboembolic disease is one of the common complications in patients with sickle cell disease (SCD). However, a recently published study shows that patient adherence to prescribed thromboprophylaxis is not very high.
Introduction
A retrospective analysis published in the journal Expert Review of Hematology focused on the adherence of hospitalized adult patients with sickle cell disease to prescribed thromboprophylaxis. While previous research in the general population shows that adherence to the enoxaparin thromboprophylactic regimen during hospitalization reaches 73–94.9%, data on SCD patients were not previously available.
Study Methodology
The study included 72 patients with a median age of 28 years who were examined in the hospital for vaso-occlusive crisis during 2019. As part of thromboprophylaxis, they were prescribed 30–40 mg of low molecular weight heparin (LMWH) enoxaparin daily. For the purposes of the analysis, they were divided into 3 groups according to adherence to the therapy:
- Group 1 received all prescribed doses.
- Group 2 received 1–99% of the prescribed doses.
- Group 3 did not take enoxaparin at all.
Thirty patients who were hospitalized repeatedly were evaluated separately.
Results
Data were evaluated from a total of 172 patient contacts. Group 1 included 26%, group 2 included 27%, and nearly half – 47% – were in group 3. Overall, only 37% of the prescribed doses were administered.
In the evaluation of patients who were hospitalized repeatedly, the results were similar. There was a total of 131 visits, with 18% of patients in group 1, 28% in group 2, and more than half – 53% – in group 3, who did not take the treatment at all. Overall, only 29% of the prescribed doses were administered in these patients.
Conclusion
Given the high risk of thromboembolic disease among patients with sickle cell disease, thromboprophylaxis is a necessary part of hospitalization that needs to be monitored to ensure that the medications are administered as prescribed. It is also worth considering that there are currently no guidelines for thromboprophylaxis in patients with SCD. Adequate communication and education regarding the application of enoxaparin, or possibly offering an alternative preparation, is essential.
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Source: Sakon C., Nikirk M., O'Brien A. R. W. Enoxaparin adherence for venous thromboembolism prophylaxis in hospitalized patients with sickle cell disease. Expert Rev Hematol 2023 Feb; 16 (2): 147–150, doi: 10.1080/17474086.2023.2162499.
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