A recent study of hospitalized patients with sickle cell disease (SCD) showed a low rate of adherence to enoxaparin for venous thromboembolism (VTE) prophylaxis. In this study, almost half of the evaluated patients did not receive any of the doses of enoxaparin that had been ordered. Results of the study were reported in the journal Expert Review of Hematology.
“Despite the high rates of VTE in hospitalized patients with SCD, there are no disease-specific guidelines for VTE prophylaxis in this population,” the researchers explained in their report. Some prior research has suggested enoxaparin is the most common prophylaxis agent prescribed to hospitalized patients who have SCD, and inpatients from the general population have shown a rate of adherence to enoxaparin ranging from 73% to 94.9%. However, data on adherence in patients hospitalized during an SCD crisis have been limited.
The study was a retrospective analysis of adults with SCD who had been admitted to the Indiana University Health system during a crisis or while experiencing acute chest syndrome. Patients were prescribed enoxaparin at 30 or 40 mg per day. For analysis, patients were divided into 3 groups according to their level of adherence, with group 1 having received 100% of the ordered doses, group 2 having received between 1% and 99% of ordered doses, and group 3 having received 0% of the ordered doses.
There were 172 total encounters with patients that were included in analyses, and these involved 72 unique patients with a median age of 28 years. Overall, 26% of patients were in group 1, having received all enoxaparin doses, and 27% were in group 2. However, nearly half of the included population (47%) were in group 3, having received none of the enoxaparin doses that were ordered. In terms of numbers of doses, 37% of the prescribed doses of enoxaparin were administered overall across the study population.
The researchers also evaluated enoxaparin adherence among patients with multiple admissions, which included 131 total encounters for 30 unique patients. Within this subset of patients, 18% of these patients were in group 1, while 28% were in group 2, and 53% of patients were in group 3. Among patients with multiple admissions, 29% of ordered enoxaparin doses were administered.
“VTE is a serious complication in patients with SCD and it is vital for the care team to assess if medications are being administered as prescribed,” the researchers wrote in their report. They advised discussing with the patient, during each admission, the risks of VTE and possible prophylaxis options. “The whole care team can play a part in making sure patients are receiving the best agent to prevent detrimental outcomes,” they concluded.
Sakon C, Nikirk M, O’Brien ARW. Enoxaparin adherence for venous thromboembolism prophylaxis in hospitalized patients with sickle cell disease. Expert Rev Hematol. Published online December 28, 2022. doi:10.1080/17474086.2023.2162499.