A review of venous thromboprophylaxis in patients undergoing hip fracture surgery (HFS)

SummaryPatients undergoing hip fracture surgery are at the highest risk category of venous thromboembolism. Incidence of deep vein thrombosis ranges between 45% and 70% and 1–7% for fatal pulmonary embolism (PE) in those unprotected by thromboprophylaxis.The National Institute of Health and Clinical Excellence (2007) recommends that “inpatients having surgery should be offered thigh length graduated compression from the time of admission to hospital” unless contraindicated. Previous guidelines (Scottish Intercollegiate 2002 Guideline Network; The Associate College of Chest Physicians 2004) have not wholly endorsed graduated compression stockings on the basis of insufficient evidence. Intermittent pneumatic compression devices and foot pumps are recommended as good alternative to pharmacological prophylaxis or combined for added protection against venous thromboembolism. Comparative to general anaesthesia, regional anaesthesia reduces risk of venous thromboembolism by 38% and 43% for DVT and PE, respectively in hip fracture patients (National Institute of Health and Clinical Excellence, 2007).Pharmacological prophylaxis comprises of unfractionated heparin, low molecular weight heparin, fondaparinux, warfarin and antiplatelets. Current guidelines recommend low molecular weight heparin and fondaparinux as a good alternative; although the latter is associated with some bleeding risk. Warfarin confers 51% and 82% risk reduction for DVT and PE, respectively. However, due to bleeding risk and its problematic therapeutic administration, warfarin is not the preferred modality.