Mechanical thromboprophylaxis for patients undergoing hip fracture surgery.

Abstract

To evaluate the rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients receiving mechanical thromboprophylaxis. 123 men and 311 women (mean age, 76 years) admitted to our institution with hip fractures were included. 95% of patient received mechanical prophylaxis using pneumatic calf pumps intermittently for 20 hours or less per day before and after surgery. At the surgeon's discretion, 161 (37%) of them received concomitant chemical prophylaxis in the form of subcutaneous low-molecular-weight heparin (enoxaparin). Signs and symptoms of DVT and PE were monitored daily, as were calf and thigh circumference. Diagnoses were confirmed by duplex ultrasonography of the lower limbs and/or spiral computed tomography scan of the thorax. 13 patients developed symptomatic venous thromboembolism (VTE); 11 were DVT and 2 were PE. Among DVT patients, 2 had proximal and 9 had distal DVT. All these patients underwent anticoagulation and were discharged without any complications. No patients developed complications from pneumatic calf pumps (foot drop, skin abrasions or stasis). Eight patients developed bleeding tendencies during hospitalisation. No patient developed surgical wound infections. 12 patients died during hospitalisation; 8 of them from acute myocardial infarction or pneumonia, and none from PE. The median length of hospital stay was significantly longer in patients with VTE. Routine use of mechanical thromboprophylaxis is recommended in patients undergoing hip fracture surgery.