Nattokinase treatment remains to be demonstrated. As in the case of any drug, the patient should receive the most complete information possible at the time of prescription, this was the case in the present study, where all patients were informed of the study design and objectives. No specific documentary information, however, was given to the patient except for the information letter approved by the ethics committee.This letter may chondroitin inhibitor have influenced compliance, in a positive direction, but was integral to good clinical practice. This was the first study of compliance in primary short course thromboprophylaxis. Previous reports focused on long course regimes, secondary prevention or curative treatment for known pathologies, with compliance ranging from 31% to 83%. Compliance was found to diminish over time, whatever the pathology, in long course treatment, non compliance impacted efficacy and mortality. The present study likewise found a fall in compliance over time, although remaining greater than 97%.
Dabigatran etexilate was chosen disufenton sodium 168021-79-2 as being the first of the new oral anticoagulants to receive market authorization for this indication in France. The daily 2 capsule dose might tend to increase the risk of poor compliance. The original electronic device recorded administration time without undoing the packaging, the electronic pill dispenser used in most compliance studies would not have been suitable for a 2 capsule dose, and moreover entails repackaging. Blood assay could have been used to check compliance, but might have biased it and, above all, would have made this observational study interventional.Patients on a low dose regime were excluded in order to avoid methodological error. The non inclusion rate in the study was high. All those discharged to an institution where care staff administer medication were excluded. This was also the reason for restricting the study to THR: in our institution, TKR cases are STI-571 systematically discharged to a rehabilitation center. The population may thus seem to have been selected, but in practice matched a population undergoing postoperative care at home: younger, with less dependence or comorbidity than the general THR population. This is the population bearing responsibility for their own treatment. In the present study, family members administered the capsules in five cases: two were compliant, and three committed at least one omission.
The risk of symptomatic venous thrombosis following THR ranges in the literature from 1.3% to 2.7%, with a 13% rate of asymptomatic venous thrombosis. A 35 40 days preventive anticoagulant regime has been shown to reduce thrombosis risk from 3.3% to 1.3%. The risk of major hemorrhagic accident is 0.7% to 0.9%, and higher in the first 10 postoperative days, at 0.1 3.1%. The present study was not intended to demonstrate drug efficacy, the observed events rate, however, was comparable to that in the stroke literature. The risk of thrombosis diminishes over time, it is particularly high during the first 15 17 days post surgery. The two distal thromboses found on echo Doppler at end of follow up received no curative treatment, as continuation of the preventive doses was sufficient. During the first 15 17 days, seven patients showed non compliance. Only one, with omission at postoperative day.