Original Research
Thromboprophylaxis After Hip Fracture: Evaluation of 3 Pharmacologic Agents
Am J Orthop. 2007 March;36(3):135-140
Author and Disclosure Information
Gerard K. Jeong, MD, Konrad I. Gruson, MD, Kenneth A. Egol, MD, Gina B. Aharonoff, MPH, Adam H. Karp, MD, Joseph D. Zuckerman, MD, and Kenneth J. Koval, MD
At the time this article was written, Dr. Jeong was Orthopaedic Surgery Resident, New York University Hospital for Joint Diseases, New York, New York. He's now in private practice in Tucson, Arizona.
Ms. Aharonoff is Member, Geriatric Hip Fracture Research Group, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York.
Dr. Gruson is Orthopaedic Surgery Resident, New York University Hospital for Joint Diseases, New York, New York.
Dr. Egol and Dr. Karp are Members, Geriatric Hip Fracture Research Group, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York.
Dr. Zuckerman is Chairman, Professor, and Member of Geriatric Hip Fracture Research Group, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York.
Dr. Koval is Professor of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and Member, Geriatric Hip Fracture Research Group, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York.
We compared the clinical efficacy and side-effect profiles of aspirin, dextran 40, and low-molecular-weight heparin (enoxaparin) in preventing thromboembolic phenomena after hip fracture surgery.
All patients admitted with a diagnosis of hip fracture to our institution between July 1, 1987, and December 31, 1999, were evaluated. Study inclusion criteria were age 65 years or older, previously ambulatory, cognitively intact, home-dwelling, and having a nonpathologic intertrochanteric or femoral neck fracture. Each patient received mechanical thromboprophylaxis (above-knee elastic stockings) and 1 pharmacologic agent (aspirin, dextran 40, or enoxaparin); patients who received aspirin were also given a calf sequential compression device. Meeting the selection criteria and included in the study were 917 patients.
Findings included low incidence of thromboembolic phenomena (deep vein thrombosis, 0.5%-1.7%; pulmonary embolism, 0%-2.0%; fatal pulmonary embolism, 0%-0.5%) and no difference among the 3 pharmacologic agents in thromboembolic prophylaxis efficacy. Use of enoxaparin was associated with a significant increase (3.8%) in wound hematoma compared with dextran 40 (1.6%) and aspirin (2.4%) (P<.01). The 3 agents were found not to differ with respect to mortality, thromboembolic phenomena, hemorrhagic complications, or wound complications.