Adherence to mechanical thromboprophylaxis after surgery: A systematic review and meta-analysis

- Mechanical prophylaxis is often used after surgery; adherence may, however, be a problem
- We performed a meta-analysis of contemporary observational surgical studies
- The pooled estimate of adherence was 75% with median follow up of 3 days
- Clinicians should consider the issue of adherence in patients for whom they prescribe thromboprophylaxis

BackgroundMany clinical practice guidelines, while recommending mechanical thromboprophylaxis after surgery, have raised concerns that discomfort may result in nonadherence. We therefore addressed adherence to mechanical thromboprophylaxis after surgery.MethodsWe searched MEDLINE from January 1, 2000 to May 21, 2015 for English-language observational studies that assessed patient adherence to mechanical thromboprophylaxis after surgery. We conducted a meta-analysis to estimate average adherence rates.ResultsWe identified 8 studies (7 for compression devices, 1 for stockings) with median follow up time of 3 days. The pooled estimate of adherence for compression devices was 75% (median 78%, range 40%-89%). Studies with shorter follow-up (≤ 3 days, n = 4, pooled adherence 75%) and longer follow-up (> 3 days, n = 3, pooled adherence 75%) reported similar adherence (p = 0.99). The studies varied in definitions of adherence, frequency of assessment, length of follow-up and completeness of reporting. No study followed patients after discharge.ConclusionsUp to one fourth of patients are nonadherent to mechanical thromboprophylaxis while hospitalized. Clinicians considering the relative merits of mechanical versus pharmacologic prophylaxis should address the issue of adherence. Strategies to improve adherence merit investigation.