Can patients with femoral neck fracture benefit from preoperative thromboprophylaxis?

Li, Qiangqiang; Dai, Bingyang; Xu, Jiacheng; Yao, Yao; Song, Kai; Zhang, Haojun; Chen, Dongyang; Jiang, Qing

doi:10.1097/md.0000000000007604

Cited by 13 publications

(11 citation statements)

References 37 publications

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“…In femoral neck fractures, the incidence of DVT was reported to be up to 19.5%. 7 In our study, the incidence was higher than in other studies. The reasons include the following aspects.…”

Section: Discussioncontrasting

confidence: 68%

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Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study

Liu

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: The actual incidence of deep vein thrombosis (DVT) in femoral neck fractures is underestimated. This study aimed to investigate the incidence of DVT in the lower extremities after femoral neck fracture before and after operation. Methods: The clinical data of patients with femoral neck fractures treated at Xi’an Honghui Hospital between July 1, 2016, and December 31, 2018, were collected. The patients were examined with ultrasonography before and after operation and divided into thrombosis and non-thrombosis groups according to their ultrasonographic results. The incidence of DVT was reported as a percentage. Results: The incidence rates of preoperative and postoperative DVT were 32% and 56%, respectively. DVT on the uninjured side constituted 45% of all preoperative DVT and 43% of all postoperative DVT. Peripheral DVT constituted 90% and 84% of all preoperative and postoperative DVT, respectively. Diabetes was an independent risk factor of preoperative DVT. Blood loss was an independent risk factor of postoperative DVT, and open reduction and internal fixation surgical procedure was independent protective factor of postoperative DVT as compared with hemiarthroplasty and total hip replacement. Conclusions: The incidence rates of preoperative and postoperative DVT in the patients with femoral neck fracture were high, and orthopedists should pay more attention to DVT as a complication.

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“…In femoral neck fractures, the incidence of DVT was reported to be up to 19.5%. 7 In our study, the incidence was higher than in other studies. The reasons include the following aspects.…”

Section: Discussioncontrasting

confidence: 68%

“…As for femoral neck fractures, the incidence of DVT is reported to range from 2.6% 2 to 19.5%. 7 However, we consider the actual incidence of DVT after femoral neck fracture is underestimated.…”

Section: Introductionmentioning

confidence: 99%

Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study

Liu

et al. 2020

J Orthop Surg (Hong Kong)

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“…Within the hip fracture population, work has suggested that the risk of VTE is in keeping with the degree of comorbidity [ 25 ]. The literature also suggests that in order to avoid VTE, early surgery (within 48 h) and pharmacological (or in combination with mechanical) thromboprophylaxis is vital [ 26 , 27 ]. The incidence of asymptomatic VTE in hip fracture patients without thromboprophylaxis is between 42%–50% [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Panteli

Giannoudi

Lodge

et al. 2021

JCM

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The aim of this study was to define the incidence and investigate the associations with mortality and medical complications, in patients presenting with subtrochanteric femoral fractures subsequently treated with an intramedullary nail, with a special reference to advancement of age. Materials and Methods: A retrospective review, covering an 8-year period, of all patients admitted to a Level 1 Trauma Centre with the diagnosis of subtrochanteric fractures was conducted. Normality was assessed for the data variables to determine the further use of parametric or non-parametric tests. Logistic regression analysis was then performed to identify the most important associations for each event. A p-value < 0.05 was considered significant. Results: A total of 519 patients were included in our study (age at time of injury: 73.26 ± 19.47 years; 318 female). The average length of hospital stay was 21.4 ± 19.45 days. Mortality was 5.4% and 17.3% for 30 days and one year, respectively. Risk factors for one-year mortality included: Low albumin on admission (Odds ratio (OR) 4.82; 95% Confidence interval (95%CI) 2.08–11.19), dementia (OR 3.99; 95%CI 2.27–7.01), presence of pneumonia during hospital stay (OR 3.18; 95%CI 1.76–5.77) and Charlson comorbidity score (CCS) > 6 (OR 2.94; 95%CI 1.62–5.35). Regarding the medical complications following the operative management of subtrochanteric fractures, the overall incidence of hospital acquired pneumonia (HAP) was 18.3%. Patients with increasing CCS (CCS 6–8: OR 1.69; 95%CI 1.00–2.84/CCS > 8: OR 2.02; 95%CI 1.03–3.95), presence of asthma/chronic obstructive pulmonary disease (COPD) (OR 2.29; 95%CI 1.37–3.82), intensive care unit (ICU)/high dependency unit (HDU) stay (OR 3.25; 95%CI 1.77–5.96) and a length of stay of more than 21 days (OR 8.82; 95%CI 1.18–65.80) were at increased risk of this outcome. The incidence of post-operative delirium was found to be 10.2%. This was associated with pre-existing dementia (OR 4.03; 95%CI 0.34–4.16), urinary tract infection (UTI) (OR 3.85; 95%CI 1.96–7.56), need for an increased level of care (OR 3.16; 95%CI 1.38–7.25), pneumonia (OR 2.29; 95%CI 1.14–4.62) and post-operative deterioration of renal function (OR 2.21; 95%CI 1.18–4.15). The incidence of venous thromboembolism (VTE) was 3.7% (pulmonary embolism (PE): 8 patients; deep venous thrombosis (DVT): 11 patients), whilst the incidence of myocardial infarction (MI)/cerebrovascular accidents (CVA) was 4.0%. No evidence of the so called “weekend effect” was identified on both morbidity and mortality. Regression analysis of these complications did not reveal any significant associations. Conclusions: Our study has opened the field for the investigation of medical complications within the subtrochanteric fracture population. Early identification of the associations of these complications could help prognostication for those who are at risk of a poor outcome. Furthermore, these could be potential “warning shots” for clinicians to act early to manage and in some cases prevent these devastating complications that could potentially lead to an increased risk of mortality.

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“…Deep venous thrombosis (DVT) and pulmonary embolism (PE) are both important clinical manifestations of venous thromboembolism (VTE). Particularly, the DVT was found to be present in 19.5–32% of patients preoperatively [ 6 , 7 ] and up to 56% of patients postoperatively [ 7 ]. Furthermore, DVT is a major resource of PE [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors

Niu

Zhao

et al. 2021

BMC Musculoskelet Disord

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Objective To investigate the epidemiologic characteristics of deep venous thrombosis (DVT) in elderly patients with femoral neck fracture. Methods Retrospective analysis was performed on elderly patients with femoral neck fractures admitted to two institutions from January 2016 to October 2019. Duplex ultrasonography (DUS) was used to detect DVT. Patients’ hospitalization medical records were retrieved to collect the data, which were related to demographics, comorbidities, injury and laboratory results on admission. Patients with preoperative DVT were defined as the case group and those without DVT as control group, and compared using the univariate analyses. Multivariate logistic regression analysis was used to identify the independent factors associated with DVT. Results Totally, 980 patients met the predefined criteria and were included. Sixty-seven patients were diagnosed to have preoperative DVT, with incidence of 6.8% for overall, 1.7% for proximal and 5.1% for distal DVT. The mean time from injury to diagnosis of DVT was 6.0 ± 4.7 days (median, 5.0). Most (76.1%) patients with DVT had thrombi solely in the injured extremity, in contrast with 14.9% (10/67) in the uninjured and 9.0% (6/67) in both injured and uninjured extremity. Multivariate analysis showed chronic renal insufficiency (OR, 3.37; 95%CI, 1.57 to 7.28), current smoking status (OR, 2.42; 95%CI, 1.23 to 5.63), time from injury to DUS (OR, 1.26; 95%CI, 1.07 to 1.61) and PLT > 220*109/L (OR, 1.94; 95%CI, 1.31 to 3.77) were independent factors for DVT. Conclusion Preoperative DVT is not very prevalent following elderly femoral neck fractures, but with a certain proportion in the uninjured extremity, necessitating the more attention. These identified risk factors aid in patient counseling, individualized risk assessment and risk stratification, and should be kept in mind.

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Can patients with femoral neck fracture benefit from preoperative thromboprophylaxis?

Cited by 13 publications

References 37 publications

Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study

Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study

Mortality and Medical Complications of Subtrochanteric Fracture Fixation

Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors

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