Optimal DVT Prophylaxis in Patients with Traumatic Hip Fracture: A Literature Review




0009-0006-5464-8920 (Meyer, Adam)

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Introduction: Hip-fracture patients face elevated life-threatening complications, including VTE and DVT. National guidelines recommend thromboprophylaxic agents such as LMWH, fondaparinux, apixaban, and warfarin. This review aims to summarize the literature investigating DVT prophylaxis in traumatic hip fracture repair, aiding healthcare professionals in clinical enhancement and agent selection. Methods: This review searched peer-reviewed articles in PubMed, Google Scholar, and Scopus. Agents considered for DVT prophylaxis included LMWH, UFH, fondaparinux, DOACs, warfarin, and aspirin. Discussion: The summary data of 9 articles suggest varying preferences for thromboprophylaxis amongst physicians managing hip fractures. LWMH is often administered subcutaneously with relatively common complications and efficient prevention of VTEs. However, due to inconvenient parenteral administration and high administration costs, low patient compliance poses a barrier. Direct Xa inhibitors, like apixaban and DOACs, have gained prominence due to easy administration, robust VTE prevention, and cost efficiency. These agents versus Lovenox yield mixed conclusions, some suggesting similar efficacy and higher incidences of hemorrhage. Fondaparinux, a synthetic anticoagulant, presents merits in VTE prevention, including a single subcutaneous injection, no need for lab monitoring, and no risk of heparin-induced thrombocytopenia. Some studies suggest fondaparinux is more effective than LWMH in preventing VTE but has a slightly higher risk of bleeding. Warfarin, a well-established anticoagulant, boasts high efficacy and safety but requires frequent lab monitoring, interacts with medications, and may lead to surgery delays. Aspirin, a widely available antiplatelet drug, is typically taken orally as a low-dose pill. Aspirin provides clinical benefits in VTE prophylaxis and becomes more appealing when considering its lower cost and decreased risks of bleeding. Conclusion: This review summarizes viable agents for VTE prevention in traumatic hip fractures. Future studies should explore how socioeconomic factors and patient health literacy impact drug adherence and efficacy. Clinicians can use this knowledge to improve outcomes in this vulnerable population.