Thromboembolism following hip fracture

Area of Science:

• Orthopedics
• Vascular Surgery
• Pulmonology

Background:

• Hip fracture surgery poses risks for venous thromboembolism.
• Deep venous thrombosis (DVT) and pulmonary embolism (PE) are significant postoperative complications.

Purpose of the Study:

• To evaluate the efficacy of low-dose intravenous heparin in preventing DVT and PE after hip fracture.
• To assess the impact of pneumatic and mechanical compression devices on DVT and PE incidence.

Main Methods:

• A study of 248 patients following hip fracture.
• Postoperative ventilation-perfusion lung scans and contrast ascending venography on days 6-8.
• Administration of low-dose intravenous heparin (3,000-5,000 units every 6 hours) in one group.

Main Results:

• Low-dose heparin decreased pulmonary embolism incidence more than twofold.
• Heparin did not significantly reduce overall deep venous thrombosis incidence.
• Thrombi in non-heparinized patients were more frequently above the knee, posing a higher PE risk.
• Compression devices did not prevent above-knee DVT but reduced PE incidence compared to controls.

Conclusions:

• Low-dose intravenous heparin is effective in reducing pulmonary embolism risk in hip fracture patients.
• While not significantly impacting overall DVT rates, heparin mitigates the risk of proximal DVT and subsequent PE.
• Mechanical and pneumatic compression devices may reduce PE risk but are less effective for preventing proximal DVT.