The Necessity to Provide an Informed Choice Regarding Venous Thromboembolism Prophylaxis: A Single-Centre Study Observing Clinician Adherence and Opinions on Venous Thromboembolism Prophylaxis

Journal article

Introduction Venous thromboembolism (VTE) prophylaxis is a critical patient safety measure used in hospitals to prevent venous thromboembolic events. These are often done via nonpharmacological methods, such as anti-embolic (TED™) stockings, or with pharmacological methods, such as low molecular weight heparin (LMWH), which consists of medications such as dalteparin. The synthesis of said medications is derived from bovine or ovine products, thus posing ethical and cultural concerns for those with dietary or religious restrictions. Fondaparinux sodium, a fully synthetic alternative, offers a non-animal-derived option, yet its use remains limited. Aims The aim of this study is to explore if those who express a preference for non-animal-derived products are appropriately prescribed fondaparinux, and to educate clinicians on the animal-derived LMWHs with the ability to provide suitable alternatives. Methodology A retrospective cohort study was conducted over a seven-week period at Royal Albert Edward Infirmary, Wigan, United Kingdom, from 16/05/25 to 07/07/25. Data were collected from patients who had expressed dietary or religious restrictions regarding animal-derived products and who were prescribed VTE prophylaxis. A secondary survey assessed prescribing clinicians' knowledge of LMWH derivatives and fondaparinux as an alternative. Results Of the 27 newly admitted patients who expressed a preference for non-animal-derived products over the seven-week period, 23 (85%) of these received VTE prophylaxis in the form of LMWH, with four (15%) receiving fondaparinux as a suitable alternative. Amongst the 24 prescribers surveyed, 12 (50%) knew LMWHs were animal-derived, with 14 prescribers (58.3%) aware of fondaparinux as a synthetic alternative. Despite this, 21 (87.5%) agreed that patients should be informed if medications contain animal-derived ingredients, with 22 (91.7%) supporting informed patient choice. Conclusion The use of VTE in a hospital setting is an imperative safety strategy and is used amongst a plethora of specialities. Those patients with expressed preferences for non-animal-derived products had unfortunately received the first-line LMWH prophylaxis, which can be due to either clinicians not having the knowledge that LMWH has animal derivatives, or that there is a suitable alternative to LMWHs. This demonstrates a clear health inequality. Educational initiatives and institutional protocols are recommended to promote patient-centred care and ensure ethical prescribing consistent with individual values.

Authors: Patel, U; Siddiqui, IRA; Lodi, A; Ziade, G; Aziz, I

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Cureus: Journal of Medical Science
• Volume: 17
• Issue: 11
• Pages: e97154
• Publication date: 2025-11-18
• Acceptance date: 2025-11-18
• DOI: 10.7759/cureus.97154
• EISSN: 2168-8184
• ISSN: 2168-8184
• Pmid: 41426795
• Language: English
• Keywords: Fondaparinux; Medical Ethics; Health Inequality; Low Molecular Weight Heparin (Lmwh); Modern Medical Practice And Patient Informed Choice