CONTINUITY OF TREATMENT BETWEEN HOSPITAL AND COMMUNITY CONCERNING PREVENTIVE ANTICOAGULATORY TREATMENT AFTER LOWER LIMB ARTHROPLASTIES

Abstract

Introduction: Currently patients who had undergone lower limb arthroplasty are discharged a few days after surgery, at which stage they still need anticoagulation treatment. The transition from hospital to the community is a sensitive period and is susceptible to mistakes and misunderstandings. Patients may underestimate the importance of the continuing treatment and their inconvenience to self-administrate subcutaneous treatment might decrease their compliance. The purpose of this prospective cohort study was to investigate the continuity of the treatment with subcutaneous low molecular weight heparin at the transition period from the hospital to the community.

Materials and Methods: 209 consecutive consenting patients who had undergone lower limb arthroplasty were recruited. Ten were excluded from the study since they were subscribed oral anticoagulation; 4 patients developed pulmonary embolism and were not included, and 8 patients were lost to follow up. 187 patients were followed weekly by phone and were asked about their adherence to the daily treatment, about clinical signs suggesting a thromboembolic event and whether they sought medical assistance. Three months later there was another clinical follow up.

Results: Of the 187 patients, 174 (93%; 95% CI 88.9% < p < 96.4%) were compliant. The percentage of doctor visits by TKR patients was statistically significantly higher, (p=0.007) than by THR patients. There was no significant difference in the compliance of patients who live with their families and patients who live alone. Patients with 0–6 years of education tend to search medical advice statistically significantly more (p=0.004) than patients with more than 7 years of education.

Discussion: The rate of compliance to anticoagulation treatment with subcutaneous low molecular weight heparin was encouraging. It demonstrates that the patients understand the necessity and importance of the treatment.