Quante M, Thate-Waschke I, Schofer M
Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Klinikum Neustadt.
Z Orthop Unfall. 2012 Sep;150(4):397-403. doi: 10.1055/s-0031-1298347. Epub 2012 Mar 15.
Today there are different subcutaneous and three oral applicable medications for prevention of venous thromboembolism after knee and hip replacement. It is a general opinion that patients will prefer oral administration. However, until today there has been no study that analysed patient preferences and motives for deciding on the kind of administration. These data would be of interest since the consideration of patient preferences could improve adherence. The present study analysed patient preferences regarding oral or subcutaneous administration of medication after elective hip or knee replacement surgery. The results will have implications for clinical practice and for decision-making concerning the kind of administration.
This prospective, multi-centric, observational study was conducted in six emergency hospitals and six rehabilitation hospitals. 178 current hip and knee replacement patients undergoing thromboprophylaxis and at least one further oral medication were interviewed. Subjective assessment data of patients were collected on study-specific questionnaires (epidemiological data, amount and background of general oral medication, details on subcutaneous thromboprophylaxis, preference of administration, causes for preference).
71.91 % of the interviewed patients preferred the daily intake of a tablet, whereas only 14.61 % favoured the daily subcutaneous injection. Main causes for the preference of oral administration were easier (86.6 % of nominations) and less complex (73.1 % of nominations) handling. 70.9 % reported that one more oral application would be unproblematic. Painlessness of oral administration was relevant for 65.7 %. Causes for preferring subcutaneous administration were "safety" (55.3 % of nominations) and an assumption of a generally better effectivity of subcutaneous (47.4 % of nominations) administration. Subjective discomfort induced by subcutaneus administration increased with the time interval since surgery. Less than 5 % of patients prefer subcutaneous administration due to the high volume of their existing oral medication.
Patient approval of oral administration is governed by practical and comfort issues. In general, patients on existing oral medications are uncritical concerning a temporary additional oral medication. The clear discomfort measured in association with subcutaneous administration supports the idea that the oral route will have advantages for patient adherence. In particular this is of relevance with increasing time interval since surgery. Patients who have a very high volume of oral medications will probably profit from subcutaneous administration. The main reasons that patients gave for the preference of subcutaneous administration are based on incorrect knowledge. Therefore it is necessary to improve patient education concerning the existing alternatives for thromboprophylaxis.
目前有多种皮下注射药物和三种口服药物可用于预防膝关节和髋关节置换术后的静脉血栓栓塞。普遍认为患者会更喜欢口服给药方式。然而，迄今为止，尚无研究分析患者在决定给药方式时的偏好和动机。考虑患者偏好可能会提高依从性，因此这些数据将很有意义。本研究分析了择期髋关节或膝关节置换术后患者对口服或皮下给药的偏好。研究结果将对临床实践和给药方式的决策产生影响。
这项前瞻性、多中心观察性研究在六家急诊医院和六家康复医院进行。对178名正在接受血栓预防治疗且至少服用一种其他口服药物的髋关节和膝关节置换患者进行了访谈。通过特定研究问卷收集患者的主观评估数据（流行病学数据、一般口服药物的数量和背景、皮下血栓预防的详细信息、给药偏好、偏好原因）。
71.91%的受访患者更喜欢每日服用片剂，而只有14.61%的患者倾向于每日皮下注射。口服给药偏好的主要原因是操作更简便（86.6%的提名）和不那么复杂（73.1%的提名）。70.9%的患者表示再多服用一种口服药物也没问题。口服给药无痛这一点占65.7%。倾向于皮下给药的原因是“安全性”（55.3%的提名）以及认为皮下给药总体效果更好（47.4%的提名）。皮下给药引起的主观不适随着术后时间间隔的增加而加重。不到5%的患者因现有口服药物剂量大而更喜欢皮下给药。
患者对口服给药的认可受实际操作和舒适度问题的影响。一般来说，正在服用现有口服药物的患者对临时额外服用口服药物并不挑剔。与皮下给药相关的明显不适支持了口服给药方式对患者依从性有优势这一观点。特别是随着术后时间间隔的增加，这一点更为重要。口服药物剂量非常大的患者可能会从皮下给药中获益。患者倾向于皮下给药的主要原因基于错误认知。因此，有必要加强关于现有血栓预防替代方案的患者教育。
