Díaz-González Candelaria de la Merced
Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Juan de Quesada, 30, 35001 Las Palmas de Gran Canaria, Spain.
Nurs Rep. 2023 May 1;13(2):765-779. doi: 10.3390/nursrep13020067.
Thromboembolic disease (TED) is an important health problem in Europe due to its high morbimortality. Pharmacological prevention is achieved with low-molecular-weight heparin (LMWH), among other strategies, which are supported by a high degree of evidence in the scientific literature. According to its safety data sheet, this injection produces local injuries at a rate of 0.1-1% after administration; however, these percentages are much lower than others reported in several studies focusing on LMWH (44-88%). This high incidence of injuries might be associated with procedural or individual variables. (1) Background: Among the most frequent side effects after the administration of LMWH are pain and haematomas (HMTs), which are influenced by obesity. We aimed to determine the relationship between abdominal skinfold (ASF) value and incidence of HMTs. In addition, I sought to determine how the risk of HMT changed with each mm increase in ASF. (2) Methods: A cross-sectional descriptive study developed in the hospital unit of orthopaedic and trauma surgery was conducted over one year. All participants in the sample were classified based on their ASF and the appearance and area of HMTs were assessed after the administration of enoxaparin. The STROBE checklist was used to evaluate the study. Descriptive statistical analysis and analysis of variance of non-parametric factors were carried out. (3) Results: In a sample of 202 participants (808 Clexane injections), more than 80% presented HMTs. More than 70% of the sample was overweight and more than 50% had an ASF > 36 millimetres (mm). (4) Conclusions: An ASF over 36 mm confers a higher risk of developing HMTs: with each mm increase in the ASF, the risk increases by 4%. Participants who are overweight or obese also present a higher risk of HMT, and these conditions correlate positively with the area of the HMTs. Providing education for the self-administration of the drug after discharge and information about the probability of suffering from local injuries in a more individualised way will lead to fewer primary care nursing consultations, more adherence to the antithrombotic treatment, and, as a consequence, a decrease in TED and health costs.
由于其高病亡率，血栓栓塞性疾病（TED）在欧洲是一个重要的健康问题。除其他策略外，低分子量肝素（LMWH）可实现药物预防，这在科学文献中有高度的证据支持。根据其安全数据表，这种注射给药后局部损伤发生率为0.1 - 1%；然而，这些百分比远低于其他一些关注LMWH的研究报告的发生率（44 - 88%）。这种高损伤发生率可能与操作或个体变量有关。（1）背景：LMWH给药后最常见的副作用是疼痛和血肿（HMTs），肥胖会对其产生影响。我们旨在确定腹部皮褶（ASF）值与HMTs发生率之间的关系。此外，我试图确定ASF每增加1毫米，HMTs风险如何变化。（2）方法：在骨科和创伤外科医院病房进行了为期一年的横断面描述性研究。样本中的所有参与者根据其ASF进行分类，并在给予依诺肝素后评估HMTs的外观和面积。使用STROBE清单评估该研究。进行了描述性统计分析和非参数因素的方差分析。（3）结果：在202名参与者（808次克赛注射）的样本中，超过80%出现了HMTs。超过70%的样本超重，超过50%的人ASF > 36毫米（mm）。（4）结论：ASF超过36毫米会使发生HMTs的风险更高：ASF每增加1毫米，风险增加4%。超重或肥胖的参与者发生HMTs的风险也更高，并且这些情况与HMTs的面积呈正相关。出院后提供药物自我给药教育以及以更个性化的方式提供关于遭受局部损伤可能性的信息，将减少初级保健护理咨询，提高对抗血栓治疗的依从性，从而降低TED和医疗成本。
