Antithrombotic drugs and patients’ outcomes at Cairo University Hospitals
Authors: Abd Elkader Sabah S.M. , Morsy Warda Y.M. , Seloma Youssria A.E. 
Published: February 2022

Background
Antithrombotic agents are widely used for thrombotic disorder management among critically ill patients. Subcutaneous administration of heparin is a repeated clinical practice done by nurses, which may cause adverse outcomes.

Aim
To investigate critical care nurses’ knowledge and practices regarding subcutaneous antithrombotic drugs and associated patients’ outcomes at Cairo University Hospitals.

Research questions
What do critical care nurses know regarding subcutaneous antithrombotic administration? What are critical care nurses’ practices regarding subcutaneous antithrombotic administration? What are the outcomes associated with subcutaneous antithrombotic drug administration among critically ill patients?

Research design
A descriptive exploratory research design.

Setting
Selected ICU affiliated to Cairo University Hospitals.

Sample
A convenience sample of 30 nurses and purposive sample of 60 adult male and female critically ill patients.

Tools of data collection
Four tools were utilized. Tool 1: critically ill patients’ personal characteristics and medical data sheet, tool 2: nurses’ knowledge-assessment questionnaire regarding subcutaneous antithrombotic drugs, tool 3: nurses’ practice observational checklist regarding subcutaneous antithrombotic drug administration, and tool 4: subcutaneous antithrombotic drug administration observational sheet of critically ill patients’ outcomes.

Results
About 60% of the studied nurses were females, 53.3% of the sample’s age ranged from 20 to less than 30 years. As well, 51.7% of critically ill patients were females, 38.3% of the sample’s age ranged from 60 to less than 70 years. The studied nurses were having unsatisfactory general knowledge level about subcutaneous anticoagulants, subcutaneous anticoagulants’ adverse effects, and nurses’ responsibilities concerning subcutaneous anticoagulants in percentages of 96.7, 96.7, and 90%, respectively. Also, unsatisfactory practice level as regards preinjection, during, and postinjection of subcutaneous anticoagulants in percentage of 100%. The most frequent adverse outcomes were localized pain, bruising, itching, and hematoma in percentages of 93, 85, 70, and 58%, respectively, where less frequent adverse outcomes were systemic thrombocytopenia, hematuria, and epistaxis in percentages of 6, 4, and 3.3%, respectively.

Conclusion
All critical care nurses had unsatisfactory knowledge and practice regarding antithrombotic therapy, inspite of their vital role in assessment, drug administration, care of critically ill patients, and monitoring drug-adverse effects. Also, the most frequent adverse outcomes among critically ill patients were pain, bruising, itching, and hematoma.

Recommendations
Updating ICU nurses’ knowledge and practice about antithrombotic drugs and maintaining close observation and record for both local and general patient’s response to antithrombotics by staff nurses during and after drug administration are highly recommended to safeguard critically ill patients against such complications.