Problemen bij subcutane toediening van laagmoleculairgewichtheparines na totale heup- en knievervangende operaties

Objective: This study aims to investigate the prevalence of administration problems with injection of low molecular weight heparins at home. Low molecular weight heparins have to be injected by patients who have undergone total hip replacement or total knee replacement surgery. Some patients might have difficulties with self-administration of low molecular weight heparins. Design and methods: A retrospective telephone interview was conducted among patients who had undergone total hip replacement or total knee replacement surgery in one of the three participating Dutch hospitals in 2008. Several questions were asked to measure health-care resource use and potential administration problems related to parenteral thromboprophylaxis. Results: 687 patients (response rate 87%) were interviewed. A total of 511 (74%) of these patients used parenteral thromboprophylaxis at home. Around 20% of the patients that used parenteral thromboprophylaxis faced problems with self-administration. Home-care visits for parenteral administration problems were required in approximately one out of ten of these orthopaedic patients. Almost 60% of all patients prefer oral above parenteral thromboprophylaxis. Conclusion: This study suggests that a small but non-negligible part of patients with total hip or total knee replacement experience problems with self-administration of parenteral thromboprophylaxis in the home setting. These patients might benefit from newer oral antithrombotic agents. Moreover it is likely that oral antithrombotic agents will be cost-saving among these patients compared to heparins, as costs of home-care for administration will be averted.