The impact of adopting low-molecular-weight heparin in place of aspirin as routine thromboprophylaxis for patients with hip fracture

Abstract

Purpose of the studyIn 2010, the National Institute for Health and Care Excellence (NICE) recommended the use of anticoagulants rather than aspirin as pharmacological thromboprophylaxis after hip fracture. We examine the impact of implementing this change in guidance on the clinical incidence of deep vein thrombosis (DVT).Study designDemographic, radiographic and clinical data were retrospectively collected for 5039 patients admitted to a single tertiary centre in the UK for hip fracture between 2007 and 2017. We calculated rates of lower-limb DVT and examined the impact of the June 2010 change of departmental policy, from use of aspirin to use of low-molecular-weight heparins (LMWH) in hip fracture patients.ResultsDoppler scans were performed in 400 patients in the 180 days after a hip fracture, and identified 40 ipsilateral and 14 contralateral DVTs (p<0.001). The rate of DVT reduced significantly following the 2010 change in departmental policy from aspirin to LMWH in these patients (1.62% vs 0.83%, p<0.05).ConclusionsThe rate of clinical DVT halved following the change from aspirin to LMWH for pharmacological thromboprophylaxis, but the number needed to treat was 127. A figure of <1% for the incidence of clinical DVT in a unit that routinely uses LMWH monotherapy following hip fracture provides a context for discussions of alternative strategies, and for power calculations for future research. These figures are important to policy makers and to researchers as they will inform the design of the comparative studies on thromboprophylaxis agents for which NICE has called.

Perioperative Administration of Tranexamic Acid and Low Molecular Weight Heparin for Enhanced Blood Management in Intertrochanteric Fractures: A Randomized Controlled Study

“…Given the high DVT risk with IF, clinical guidelines universally recommend postoperative anticoagulation. In this study, we administered LMWH within 24 h postoperatively, which can significantly reduce postoperative DVT after hip fractures, with high safety and efficacy [18,19]. Patients were divided into 2 experimental groups: those receiving 4 intravenous Other specified hemorrhagic events (gastrointestinal bleeding, hematuria) 0 0 0 0 APPROVED GALLEY PROOF doses of TXA+LMWH (the 4-dose group) and those receiving a single intravenous dose of TXA+LMWH (the 1-dose group).…”

“…It works by enhancing the activity of antithrombin III, thus inhibiting thrombin formation and factor Xa, crucial steps in the coagulation cascade [ 17 ]. LMWH is widely acknowledged to significantly reduce the occurrence of DVT following hip fracture procedures, and it is generally recommended for use within 24 h postoperatively [ 18 , 19 ]. A study performed by Zhou et al included 100 IF patients and aimed to investigate the effectiveness and safety of TXA in reducing bleeding and the need for transfusion, indicating that TXA significantly reduced total, intraoperative, and hidden blood loss compared to the control group, without increasing the rate of complications [ 10 ].…”