Mechanical prophylaxis after hip fracture: what is the risk of deep vein thrombosis? A retrospective observational study

Protty, Majd; Aithal, S; Hickey, Ben; Pettit, Rebecca; Johansen, Antony

doi:10.1136/bmjopen-2014-006956

Cited by 16 publications

(9 citation statements)

References 25 publications

(20 reference statements)

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“…Considering the high incidence of VTE and overwhelming percentage of asymptomatic ICMVT after femoral neck fracture, we proposed that routine screening for DVT in lower extremities with Doppler ultrasonography prior to fracture surgery be required. Notably, DVTs in our study were discovered mostly on the ipsilateral side of the fracture, and a similar finding has shown a significant tendency for DVTs to occur on the same side as the hip fracture, suggesting local vessel injury and immobility of affected limb may be more important than general hypercoagulability in causing DVT after hip fracture [ 21 ].…”

Section: Discussionsupporting

confidence: 64%

Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture

et al. 2018

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BackgroundLimited studies are available to investigate the prevalence of preoperative venous thromboembolism (VTE) in elderly patients with femoral neck fractures. Our primary aim was to determine the incidences of VTE and its risk or protective factors in such patient population. The secondary objective was to evaluate the need of therapeutic anticoagulation for isolated calf muscular venous thrombosis (ICMVT) prior to femoral neck fracture surgery.MethodsThis is a retrospective case-control study, including 301 femoral neck fracture patients who were admitted to our institution between January 2014 and March 2017. Bilateral Doppler ultrasonography was performed in each of the patients as a preoperative VTE screening. The event rate of VTE was calculated, and significant risk or protective factors were determined by using a multivariate logistic regression model. Patients with ICMVT were divided into anticoagulation and no anticoagulation groups to assess the efficacy and safety of preoperative therapeutic anticoagulation. Intraoperative blood loss, drainage volume, blood transfusion, perioperative hemoglobin change, and rate of thrombosis extension were compared between the two groups.ResultsThe overall preoperative incidence of VTE in patients with femoral neck fracture was 18.9% (57/301), in which deep vein thrombosis (DVT) was 18.9% and pulmonary embolism (PE) was 1%. Among the DVT cases, 77.2% (44/57) were ICMVTs. Multiple fractures (odds ratio [OR] = 9.418; 95% confidence interval [CI] = 2.537 to 34.96), coexisting movement disorder (OR = 3.862; 95% CI = 1.658 to 8.993), bed rest for more than 7 days (OR = 2.082; 95% CI = 1.011 to 4.284) as well as elevated levels of D-dimer (OR = 1.019; 95% CI = 1.002 to 1.037) and fibrinogen (OR = 1.345; 95% CI = 1.008 to 1.796) led to an increase in the risk of VTE, while the recent use of antiplatelet drug (OR = 0.424; 95% CI = 0.181 to 0.995) and prophylactic anticoagulation (OR = 0.503; 95% CI = 0.263 to 0.959) decreased the risk of VTE. For the 39 patients with ICMVT undergoing femoral neck fracture surgery, there were no significant differences in the rate of thrombosis extension between anticoagulation and no anticoagulation groups, but significantly decreased postoperative hemoglobin was observed in the anticoagulation group.ConclusionOur findings showed a high prevalence of preoperative VTE in elderly patients with femoral neck fracture, with risk factors identified. We found that the most detected VTE were ICMVTs. Our study suggested that a direct surgery without preoperative use of therapeutic anticoagulation for ICMVT would not reduce the risk of thrombus extension, and the therapeutic use of anticoagulation may worsen postoperative anemia.

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Section: Discussionsupporting

confidence: 64%

Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture

et al. 2018

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“…It is estimated that the number of hip fractures is approximately 1.7 million each year, and the number is expected to surpass 6 million by the year 2050 worldwide [ 2 ]. When a hip fracture occurs, the risk of venous thromboembolism (VTE) increases obviously in the preoperative period owing to the venous congestion, vascular injury and immobilization [ 3 ]. Deep vein thrombosis (DVT) is one of the common complications in patients with hip fractures.…”

Section: Introductionmentioning

confidence: 99%

Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study

Fan

Zhou

et al. 2021

BMC Musculoskelet Disord

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Background Limited studies were available to investigate the prevalence of deep vein thrombosis (DVT) on admission in elderly patients with intertrochanteric fractures. The aim of present study was to evaluate risk factors and the prevalence of pre-admission DVT in elderly patients with intertrochanteric fractures. Methods This retrospective study included 788 elderly patients with intertrochanteric fracture who were eligible for this study from January 1, 2010, to December 31, 2019. Color doppler ultrasonography was performed for DVT detection at admission. All patients’ clinical data were collected. Univariate analysis and stepwise backward multivariate logistic regression were used to identify the risk factors contributing to the occurrence of DVT. Results The overall prevalence of pre-admission DVT in patients with intertrochanteric fractures was 20.81% (164 of 788 patients). The mean time from injury to admission was 2.1 days in the total population, 2.96 and 1.87 days in patients with and without DVT. Univariate analysis showed that significantly elevated risk of DVT were found in patients with longer time from injury to admission, high energy injury, lower Hb value, higher BMI, diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation, dementia, varicose veins, higher age-adjusted CCI, higher ASA class and A3 type intertrochanteric fractures (P < 0.05). The adjusted multivariate logistic regression analysis demonstrated that longer time from injury to admission, high energy trauma, COPD, lower Hb, diabetes and A3 type intertrochanteric fractures were independent risk factors of pre-admission DVT. Conclusions A high prevalence of pre-admission DVT was found in elderly Chinese patients with intertrochanteric fractures. Therefore, surgeons should be aware of the high prevalence of DVT for elderly patients with intertrochanteric fractures in order to prevent intraoperative and postoperative PE and other lethal complications.

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“…Two studies on prognostic factors for mortality after hip fracture showed that age, sex, and number of comorbidities influenced both early and late mortality in patients suffering from proximal hip fractures, and the option of operating within 3 days was not a valid alternative. In our study, the patients in the two groups had a surgery waiting time of more than 4 days, and they were fully evaluated before and after surgery and were administered mechanical prophylaxis before surgery and extended prevention of VTE after surgery according to guidelines. No deaths caused by thrombosis occurred in the 3 months after surgery.…”

Section: Discussionmentioning

confidence: 77%

Comparison of the Efficacy and Safety of Aspirin and Rivaroxaban Following Enoxaparin Treatment for Prevention of Venous Thromboembolism after Hip Fracture Surgery

Huang

Xing

Zeng

et al. 2019

Orthopaedic Surgery

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Objective To compare the efficacy and safety of aspirin with rivaroxaban following treatment with enoxaparin for prevention of venous thromboembolism (VTE) after hip fracture surgery (HFS). Methods A total of 390 patients were enrolled in the trial. According to an odd or even number at the end of their registration number, the patients were divided into the aspirin group (n = 198) and the rivaroxaban group (n = 192). All patients were given enoxaparin subcutaneous injection after the operation and returned to the routine dose the next day until postoperative day five. The patients in the aspirin group received an additional 16 days of thromboprophylaxis with 100 mg of aspirin once daily. The rivaroxaban group was assigned to receive an additional 16 days of thromboprophylaxis with 10 mg of oral rivaroxaban once daily. Patients were followed for 90 days regarding VTE and bleeding complications. Results The incidence of VTE in the aspirin group and rivaroxaban group was 6.6% (13/198) and 5.7% (11/192), respectively (P = 0.83). The rate of major bleeding events occurred in two (1.0%) patients in the aspirin group and in one patient (0.5%) in the rivaroxaban group (P = 1.0). A combination of major bleeding and clinically relevant nonmajor bleeding occurred in five patients (2.5%) in the aspirin group and in six patients (3.1%) in the rivaroxaban group (P = 0.77). During the 90‐day follow‐up, a pulmonary embolism developed in one patient (0.5%) in the aspirin group and none in the rivaroxaban group (P = 1.0). Conclusions Extended prophylaxis for 21 days with aspirin was equivalent to the direct oral anticoagulant rivaroxaban after hip fracture surgery with an initial 5‐day postoperative course of enoxaparin. Aspirin may be an effective, safe, convenient, and cheap alternative for extended prophylaxis after hip fracture surgery.

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Mechanical prophylaxis after hip fracture: what is the risk of deep vein thrombosis? A retrospective observational study

Cited by 16 publications

References 25 publications

Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture

Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture

Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study

Comparison of the Efficacy and Safety of Aspirin and Rivaroxaban Following Enoxaparin Treatment for Prevention of Venous Thromboembolism after Hip Fracture Surgery

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