The Effectiveness of Local Combined Cold-Hot Application on Bruising of Enoxaparin Sodium

Introduction: Bruising is one of the most common adverse events following administration of enoxaparin sodium, which can lead to unpleasant consequences such as reduced access to various sites for injection, joint complaints, and reduced satisfaction of patients from the treatment and care provided. Therefore, in order to find ways to reduce this complication, the aim of this study was to compare the effectiveness of local combined cold-hot application on bruising caused by subcutaneous injection of enoxaparin sodium.

Methods: This randomized controlled trial was conducted from July to December 2018. 74 patients hospitalized in Poursina Hospital in Rasht were selected according to inclusion criteria and assigned to intervention group 1 (37 persons) and intervention group 2 (37 persons) by randomized block design. In each intervention group, the left side of the abdomen was treated as control (without intervention) and the right side was treated with cold pack (intervention group 1) or cold-hot pack (intervention group 2). Data collection was done by two-part tools, including individual and clinical data, and related records of bruising. Evaluation of the incidence and severity of bruising was performed at 24, 48, 72 hours after the first injection. Data were analyzed by SPSS version 22 using descriptive and inferential statistics (Independity Test, Friedman, Wilcoxon, Mann-Whitney, Kolmogorosimerno).

Results: The majority of research samples were men (79.7%). The mean age of the patients was 21 ± 48 years. The mean and standard deviation of bruising in intervention group 1 at 24, 48 and 72 hours after injection was 24.44±1.09, 4.49±1.04 and 4.35±1.14, respectively. The mean and standard deviation of bruising in intervention group 2 at 24, 48 and 72 hours after injection was 1.65±0.63, 1.49±0.65, and 0.88±0.43, respectively. Differences in bruising size were statistically significant (P<0.001).

Conclusion: The findings of this study showed that use of local cold-hot pack compared to cold pack is more effective regarding the size of bruising in place of enoxaparin sodium injection, which is clinically important.