Deep Vein Thrombosis and Thromboembolism: Prevention and Treatment in Hip Fracture Patients

15 Deep Vein Thrombosis and Thromboembolism

Prevention and Treatment in Hip Fracture Patients

Venous thromboembolism (VTE) is a complication of hip fracture and its subsequent surgical treatment.


Patients with proximal femoral fractures often have preexisting medical conditions. The initial trauma, subsequent surgery, and subsequent relative immobility may provoke further medical problems. VTE is one of the most likely complications of this injury.


Mechanical Methods

Orthopaedic surgeons have to balance risk and benefit in the perioperative period. Therefore, they intuitively find mechanical methods appealing because these methods carry no bleeding risk. All mechanical methods have the disadvantages of expense and noncompliance. Furthermore, these methods are not practical for, nor is there evidence for, extended prophylaxis. Very few data are derived from hip fracture patients. However, one can reasonably extrapolate from other surgical studies.

Chemical Methods

Chemical methods are generally easy to administer (tablet or injection) and can be used for an extended duration. They are fairly inexpensive relative to the overall cost of surgery. However, orthopaedic surgeons are properly concerned about the risk of bleeding inherent in the use of these agents.


Aspirin was not recommended for use after hip fracture by the three authoritative evidence-based guidelines groups.1416 This drug is predominantly an antiplatelet agent rather than an antithrombotic agent. The Pulmonary Embolism Prevention (PEP) study17 compared 13,000 hip fracture patients with or without aspirin for prophylaxis. The investigators reported a risk reduction for symptomatic VTE of approximately 25%, but this was matched by an increase in bleeding problems. The death rate was unchanged in either group. The risk reduction achieved is far lower than that noted with low-molecular-weight heparin (LMWH) or fondaparinux. Furthermore, aspirin carries a risk of gastrointestinal complications and bleeding, particularly in elderly patients.18

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Aug 24, 2016 | Posted by in ORTHOPEDIC | Comments Off on Deep Vein Thrombosis and Thromboembolism: Prevention and Treatment in Hip Fracture Patients
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