Venous thromboembolic prophylaxis for hip fractures

Marsland, Daniel; Mears, Simon C.; Kates, Stephen L.

doi:10.1007/s00198-010-1403-2

Cited by 35 publications

(29 citation statements)

References 96 publications

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“…Fondaparinux or low-molecular weight heparin for 28 to 35 days after surgery seems to be the best evidence-based recommendation at this time. 43,186,187 Warfarin is an alternative reasonable choice for therapy and is often used in patients who were taking warfarin prior to fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Early surgery and early mobilization have been shown to reduce the likelihood of thrombosis and should be instituted whenever possible. 43 …”

Section: Stephen L Kates Mdmentioning

confidence: 99%

“…Low-molecular weight heparins such as dalteparin and enoxaparin have been shown to be very effective as prophylaxis of VTE after hip fractures. 43 Unfractionated heparin is typically used as a twice daily subcutaneous injection and is inexpensive. It is also effective as a prophylactic agent, particularly in the inpatient setting where the twice daily administration is less problematic.…”

Section: Pharmacologic Prophylaxismentioning

confidence: 99%

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A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

134

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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Section: Discussionmentioning

confidence: 99%

“…Early surgery and early mobilization have been shown to reduce the likelihood of thrombosis and should be instituted whenever possible. 43 …”

Section: Stephen L Kates Mdmentioning

confidence: 99%

Section: Pharmacologic Prophylaxismentioning

confidence: 99%

See 1 more Smart Citation

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

134

121

View full text Add to dashboard Cite

show abstract

“…Peri-operative thromboprophylaxis with acetylsalicylic acid, low-molecular weight heparin and fondaparinux have all been found to reduce the incidence of venous thromboembolic events after hip fracture surgery, but the effect on mortality is unresolved [96][97][98]. Studies have been prone to selection bias, excluding the frailest and those with increased risk of peri-operative bleeding, and so may not be representative of outcomes in the general hip fracture population.…”

Section: Postoperative Carementioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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“…The treatment for patients with a markedly elevated INR is controversial, with options ranging from watchful waiting to the use of oral vitamin K or fresh-frozen plasma. 18 If the INR is less than 1.5, surgical intervention may proceed. The treatment for an elevated INR is complicated by the acute need for the patient with a hip fracture to undergo surgical fixation.…”

Section: Admission To the Hospital (S Mears)mentioning

confidence: 99%

A Guide to Improving the Care of Patients With Fragility Fractures

Bukata

DiGiovanni

Friedman

et al. 2011

Geriatr Orthop Surg Rehabil

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ForewordFragility fractures, low-energy injuries that occur from a fall from a standing or lower height, represent a serious public health problem. After age 50, the lifetime risk of having a fragility fracture is 33% for an American woman and 20% for a man. 1 In the United States, 2.1 million people will suffer a fragility fracture each year.1 The incidence of fragility fractures increases steeply after age 65.2 Osteoporosis is present in most patients with a fragility fracture.Hip fractures are the most serious in terms of cost and morbidity. The average cost of inpatient care for a hip fracture in 2005 was $33 962.3 The lifetime risk of having a hip fracture is 6% for men and 17.5% for women. Although the mortality risk after a hip fracture is much higher for a man, a woman's risk of dying from a hip fracture is high and exceeds the lifetime risk of death from breast cancer, uterine cancer, and ovarian cancer combined. For those who survive after a hip fracture, most do not regain their preinjury level of function, and 30% lose their independence. This loss of independence is greatly feared by patients and is very costly to patients and society.Although a hip fracture may have the most serious consequences, other bones, such as the wrist, shoulder, ankle, pelvis, and spine, frequently fracture in the osteoporotic patient. For example, the lifetime risk of a forearm or vertebral compression fracture is 16% and 15.6%, respectively, for a woman and 2.5% and 5%, respectively, for a man. 4 These statistics clearly show that fragility fractures are a major problem facing American society today, 5 and the care of such fractures presents an even greater challenge, in part because the quality of care delivered in the United States varies widely, even within one region. Many such fractures are treated in an outpatient setting, although some may be treated in the inpatient hospital setting. However, the quality of care for seniors with fragility fractures receives relatively little attention. In 2004, the United States Surgeon General issued a comprehensive report calling for health professionals to make significant improvements in our nation's bone health, and an improvement in the system and methods of care was suggested. 5There has been little written on the subject of improving the system of care delivery in the United States.The goals of this blue book are to review the methods used in inpatient and outpatient care, as well as rehabilitation of the patient with a fragility fracture. We discuss evidence-based best care models and, where evidence is lacking, present expert opinions in an effort to improve the standard and the quality of care for the patient with a fragility fracture. We hope that this monograph will provide guidance to physicians, nurses, rehabilitation therapists, other health care providers, and administrators.Stephen L. Kates, MD Editor-in-Chief Simon C. Mears, MD, PhD

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Venous thromboembolic prophylaxis for hip fractures

Cited by 35 publications

References 96 publications

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

A Guide to Improving the Care of Patients With Fragility Fractures

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