The post operative prescription of prophylactic enoxaparin and the adherence to the prescribed regimen in gynaecologic oncology patients at Charlotte Maxeke Johannesburg Academic Hospital

Abstract

Introduction: Patients with gynaecological malignancy, particularly postsurgery, are at an increased risk of venous thromboembolism, which poses a significant risk of morbidity and mortality. Low molecular weight heparin is effective for thromboprophylaxis, with less risk of bleeding and side effects than unfractionated heparin. The Southern African Society of Thrombosis and Haemostasis recommends initiating enoxaparin within 6-12 hours postsurgery, provided there is no risk of bleeding. This study aimed to assess whether thromboprophylaxis guidelines are being followed in the Gynaecology Oncology unit in a tertiary hospital in Johannesburg, South Africa. It was a retrospective descriptive study where medical records of patients who had surgery for gynaecological malignancy were reviewed. Results: During the study period (1st May 2020 to 31st June 2022), 182 patients had surgery in the Gynaecology Oncology unit. Forty patients were excluded, of whom six 6 had an operation for non-malignancy disease and 34 had missing records. A total of 142 patients’ records were analysed. The mean age was 49.5 years; most patients were Black and non-smokers. The organ most involved was the ovary (33.1%), followed by the cervix (25.5%), with the vulva and the uterus less commonly involved. The surgery most performed was laparotomy and the mean duration of the operation was 104 minutes. In most prescriptions n=80 (56.3%), the time to initiate enoxaparin postsurgical was not specified. However, most patients received their postoperative enoxaparin within the recommended six to 12 hours postsurgery. Consultants were more likely to specify the time for initiating enoxaparin postoperatively than registrars and subspecialists. Conclusion: This study found that doctors in the Gynaecology Oncology Unit were not adhering to thromboprophylaxis guidelines, however in the wards enoxaparin is administered within the appropriate time as per guidelines.