Introduction and Aim: Low molecular weight heparin (LMWH) is recommended for thromboprophylaxis in accordance to scientific guidelines. İt has been observed in our clinic that puerperal patients have some disruptions and compliance problems with this treatment. İn our study, it was aimed to reveal the incidence of non- compliance with this treatment and the most seen reasons for non-compliance .

Materials and Methods: This is a prognostic cohort study. This research was carried out in an education and research hospital between January- June 2019. Ethics committee approval was received. Informed consent was obtained from all patients. The target group of the study was postpartum, inpatient women older than 18 years and which were prescribed LMWH according to guidelines. Of the 2560 women who delivered during the stıdy period, 441 had indications for LMWH treatment. Two  hundred eighty one puerperal patient fullfilled eligibility criteria.. The research follow-up process was completed by evaluating the puerperal patients at 2 different times. The first evaluation was performed face-to-face in the hospital, at postpartum 24-48 hours. Socio-demographic features, obstetric history and medical characteristics of the last pregnancy were recorded at first evaluation. The second interview was scheduled at the patient's discharge and the patient was given a written appointment paper. Any patient who did not attend the appointment were called once and second interview was completed via telephone call. Duration, number and method of LMWH use and why if she did not use the drug were asked in the second interview. The steps of patient information process were evaluated by structured questions  in the data collecting form. Also the prescribed medication and if the patient supplied the drug were checked and verified via electronic prescription system. Compliance was defined as use of 80% of prescribed LMWH doses. Normality of continious variables was assessed with Kolmogorov-Smirnov’s test. Differences for mumerical data between puerperas with drug compliance and drug non-compliance were compared with Mann- Whitney U Test. Chi-square test was performed for categorical variables. Statistical significance was defined as a p< 0,05.

Results: Non-compliance for postpartum LMWH prophylaxis was 27% among our study population. Among socio-demographic features, social insurance contribution for drug supply was statisticaly significant for compliance, p=0,002, RR 1,98 (95% CI 1,32-2,97). Non-smokers drug compliance was better than previously smoked and/or still smoking women, p= 0,016, RR 1,21 (95% CI 1,21-1,44). Postpartum and total length of hospital stay showed difference among compliant and non-compliant patients p< 0,01 and p< 0,03. Evaluating the patient information process according to rational use of medicine principles, every step showed difference between compliant and non-compliant women; being informed about duration of theraphy, p< 0,001 RR 3,21 (95% CI 2,22-4,65), beimg informed about necessity of theraphy, p= 0,034 RR 1,6 (95% CI 1,01-2,53).

Discussion and Recommendations: Compliance with  LMWH use for postpartum thromboprophylaxis is insufficient in in our study population. Lewey et al. reported that co-payment reduction for drugs, improved adherence. İn our study, we find out that women without a social insurance contribution for drug supply are more non-compliant. Negative and decisive effects of smoking on drug adherence and cessation of treatment were previously published. İnsufficient patient information rates are related with drug compliance. This is the main reason for our study population. The benefits of providing structured patient education and adequate information should be studied. Reformative arrangements should be made within the clinic.

Key words: Drug adherence , drug compliance, postpartum thromboprphylaxis, rational use of medicines

All of the authors declare that they have no conflict of interest.