Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov:34 Suppl 3:S70-S75.
doi: 10.1097/BOT.0000000000001939.

Venous Thromboembolism in Hip Fracture Patients: A Subanalysis of the FAITH and HEALTH Trials

David R W MacDonald  1 , David Neilly, Prism S Schneider, Sofia Bzovsky, Sheila Sprague, Daniel Axelrod, Rudolf W Poolman, Frede Frihagen, Mohit Bhandari, Marc Swiontkowski, Emil H Schemitsch, Iain M Stevenson; FAITH Investigators; HEALTH Investigators
Collaborators, Affiliations

Venous Thromboembolism in Hip Fracture Patients: A Subanalysis of the FAITH and HEALTH Trials

David R W MacDonald et al. J Orthop Trauma. 2020 Nov.

Abstract

Background: The primary objective of this study was to determine the incidence of symptomatic venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), in the hip fracture population. Secondary objectives included determining timing of VTE diagnosis, VTE thromboprophylaxis given, and identifying any factors associated with VTE.

Methods: Using data from the FAITH and HEALTH trials, the incidence of VTE, including DVT and PE, and the timing of VTE were determined. A multivariable Cox regression analysis was used to determine which factors were associated with increased risk of VTE, including age, treatment for comorbidity, thromboprophylaxis, time to surgery, and method of fracture management.

Results: 2520 hip fracture patients were included in the analysis. Sixty-four patients (2.5%) had a VTE [DVT: 36 (1.4%), PE: 28 (1.1%)]. Thirty-five (54.7%) were diagnosed less than 6 weeks postfracture and 29 (45.3%) more than 6 weeks postfracture. One thousand nine hundred ninety-three (79%) patients received thromboprophylaxis preoperatively and 2502 (99%) received thromboprophylaxis postoperatively. The most common method of preoperative (46%) and postoperative (73%) thromboprophylaxis was low molecular weight heparin. Treatment with arthroplasty compared to internal fixation was the only variable associated with increased risk of VTE (hazard ratio 2.67, P = 0.02).

Conclusions: The incidence of symptomatic VTE in hip fracture patients recruited to the 2 trials was 2.5%. Although over half of the cases were diagnosed within 6 weeks of fracture, VTE is still prevalent after this period. The majority of patients received thromboprophylaxis. Treatment with arthroplasty rather than fixation was associated with increased incidence of VTE.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

References

    1. Todd C, Freeman C, Camilleri-Ferrante C, et al. Differences in mortality after fracture of hip: the East Anglian audit. BMJ 1995;310:904–908.
    1. Geerts WH, Code KI, Jay RM, et al. A prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994;331:1601–1606.
    1. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary Embolism Prevention (PEP) trial. Lancet. 2002;355:1295–1302.
    1. Eriksson BI, Lassen MR. PENTasaccharide in HIp-FRActure Surgery Plus Investigators. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicentre, randomized, placebo-controlled, double blind study. Arch Intern Med. 2003;163:1337–1342.
    1. Rosencher N, Vielpeau C, Emmerich J, et al. Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study. J Thromb Haemost. 2005;3:2006–2014.

MeSH terms

Substances