J Korean Orthop Assoc.  2016 Oct;51(5):378-386. 10.4055/jkoa.2016.51.5.378.

Preoperative Enoxaparin versus Postoperative Enoxaparin Thromboprophylaxis in Hip Fracture Surgery: Is Preoperative Enoxaparin Safe to Use?

• Moon NH
• Jang JH
• Park JS
• Park KY
• Park YG

• KMID: 2355502
• DOI: http://doi.org/10.4055/jkoa.2016.51.5.378

Abstract

PURPOSE
The purpose of this study was to evaluate the safety and efficacy of pre- and postoperative initiation of enoxaparin in treatment of hip fracture.
MATERIALS AND METHODS
In this study, we enrolled 629 consecutive patients with hip fracture who Pusan National University Hospital between March 2009 and March 2014. Of these patients, 414 patients (65.8%) met the final inclusion criteria. Enoxaparin was administered subcutaneously at 40 mg once daily starting 48 hours after surgery in 156 patients (group A), and immediately after admission in 258 patients (group B). The incidence of symptomatic venous thromboembolism (VTE) and risk of bleeding during hospitalization period were compared between groups.
RESULTS
The incidence of symptomatic VTE during the hospitalization period was 7.1% (11 patients) in group A and 5.4% (14 patients) in group B. No significant difference in the rate of symptomatic VTE was found between the groups (unadjusted odds ratio [OR], 0.756; 95% confidence interval [CI], 0.334-1.710; adjusted OR, 0.554; 95% CI, 0.212-1.449). The incidence of symptomatic deep-vein thrombosis and pulmonary embolism (including fatal and non-fatal) did not significantly differ between groups. However, fatal pulmonary thromboembolism developed in two cases in group A and one patient expired postoperatively due to pulmonary hemorrhage in group B. Major bleeding and all-cause death did not differ between groups.
CONCLUSION
Preoperative starting chemical thromboprophylaxis may be considered in the elderly patients with hip fracture who have risk factors for venous thromboembolism.

Keyword

venous thromboembolism; hip fractures; low molecular weight heparin

MeSH Terms

Aged
Busan
Enoxaparin*
Hemorrhage
Heparin, Low-Molecular-Weight
Hip Fractures
Hip*
Hospitalization
Humans
Incidence
Odds Ratio
Pulmonary Embolism
Risk Factors
Venous Thromboembolism
Venous Thrombosis
Enoxaparin
Heparin, Low-Molecular-Weight

Figure

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  Figure 1 Flow chart of patient enrollment.

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  Figure 2 Independent risk factors for thromboembolism in patients with hip fractures. BMI, body mass index; DVT, deep vein thrombosis; fx, fracture; ASA, American Society of Anesthesiologists; EBL, estimated blood loss; Group A, postoperative enoxaparin; OR, odds ratio.

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