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The impact of adopting low-molecular-weight heparin in place of aspirin as routine thromboprophylaxis for patients with hip fracture
  1. Arwel T Poacher1,
  2. Hannah C Hoskins1,
  3. Majd B Protty2,
  4. Rebecca Pettit3,
  5. Antony Johansen1,4
  1. 1Trauma Department, University Hospital of Wales, Cardiff, UK
  2. 2Systems Immunity University Research Institute, Cardiff University, Cardiff, UK
  3. 3Department of Medical Physics, University Hospital of Wales, Cardiff, UK
  4. 4Cardiff University School of Postgraduate Medical and Dental Education, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Arwel T Poacher, Trauma Department, University of Wales Hospital, Cardiff, South Glamorgan, UK; drarwelpoacher{at}gmail.com

Abstract

Purpose of the study In 2010, the National Institute for Health and Care Excellence (NICE) recommended the use of anticoagulants rather than aspirin as pharmacological thromboprophylaxis after hip fracture. We examine the impact of implementing this change in guidance on the clinical incidence of deep vein thrombosis (DVT).

Study design Demographic, radiographic and clinical data were retrospectively collected for 5039 patients admitted to a single tertiary centre in the UK for hip fracture between 2007 and 2017. We calculated rates of lower-limb DVT and examined the impact of the June 2010 change of departmental policy, from use of aspirin to use of low-molecular-weight heparins (LMWH) in hip fracture patients.

Results Doppler scans were performed in 400 patients in the 180 days after a hip fracture, and identified 40 ipsilateral and 14 contralateral DVTs (p<0.001). The rate of DVT reduced significantly following the 2010 change in departmental policy from aspirin to LMWH in these patients (1.62% vs 0.83%, p<0.05).

Conclusions The rate of clinical DVT halved following the change from aspirin to LMWH for pharmacological thromboprophylaxis, but the number needed to treat was 127. A figure of <1% for the incidence of clinical DVT in a unit that routinely uses LMWH monotherapy following hip fracture provides a context for discussions of alternative strategies, and for power calculations for future research. These figures are important to policy makers and to researchers as they will inform the design of the comparative studies on thromboprophylaxis agents for which NICE has called.

  • Thromboembolism
  • Orthopaedic & trauma surgery
  • Trauma management
  • CLINICAL PHARMACOLOGY
  • Hip

Data availability statement

No data are available. Anonymous data are available on reasonable request from ATP. Reuse is not permitted unless permission is explicitly granted by authors.

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Data availability statement

No data are available. Anonymous data are available on reasonable request from ATP. Reuse is not permitted unless permission is explicitly granted by authors.

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Footnotes

  • Twitter @arwelpoacher

  • ATP and HCH contributed equally.

  • Contributors ATP prepared and edited the manuscript, submitted the study. HCH collected the data, and prepared and edited the manuscript. reviewed the data, and prepared and reviewed the manuscript. RP collected data and reviewed the manuscript. MP reviewed the data, and prepared and reviewed the manuscript. AJ designed the study, prepared and reviewed the manuscript and is it guarantor. All authors gave final approval to the submitted paper. Thanks to the Medical School Students for their participation and feedback.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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