Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2016 Oct;51(5):378-386. Korean.
    Published online Oct 26, 2016.
    https://doi.org/10.4055/jkoa.2016.51.5.378
    Copyright © 2016 by The Korean Orthopaedic Association
    Original Article

    Preoperative Enoxaparin versus Postoperative Enoxaparin Thromboprophylaxis in Hip Fracture Surgery: Is Preoperative Enoxaparin Safe to Use?

    Nam Hoon Moon, M.D., Jae-Hoon Jang, M.D., Jin Sup Park, M.D.,* Ki Young Park, M.D. and Young Gun Park, M.D.
      • Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea.
      • *Department of Cardiology, Pusan National University Hospital, Busan, Korea.
    • Correspondence to: Jae-Hoon Jang, M.D. Department of Orthopaedic Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. TEL: +82-51-240-7248, FAX: +82-51-247-8395, Email: ansskagns@daum.net
    Received April 07, 2016; Revised May 03, 2016; Accepted June 01, 2016.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    The purpose of this study was to evaluate the safety and efficacy of pre- and postoperative initiation of enoxaparin in treatment of hip fracture.

    Materials and Methods

    In this study, we enrolled 629 consecutive patients with hip fracture who Pusan National University Hospital between March 2009 and March 2014. Of these patients, 414 patients (65.8%) met the final inclusion criteria. Enoxaparin was administered subcutaneously at 40 mg once daily starting 48 hours after surgery in 156 patients (group A), and immediately after admission in 258 patients (group B). The incidence of symptomatic venous thromboembolism (VTE) and risk of bleeding during hospitalization period were compared between groups.

    Results

    The incidence of symptomatic VTE during the hospitalization period was 7.1% (11 patients) in group A and 5.4% (14 patients) in group B. No significant difference in the rate of symptomatic VTE was found between the groups (unadjusted odds ratio [OR], 0.756; 95% confidence interval [CI], 0.334–1.710; adjusted OR, 0.554; 95% CI, 0.212–1.449). The incidence of symptomatic deep-vein thrombosis and pulmonary embolism (including fatal and non-fatal) did not significantly differ between groups. However, fatal pulmonary thromboembolism developed in two cases in group A and one patient expired postoperatively due to pulmonary hemorrhage in group B. Major bleeding and all-cause death did not differ between groups.

    Conclusion

    Preoperative starting chemical thromboprophylaxis may be considered in the elderly patients with hip fracture who have risk factors for venous thromboembolism.

    Keywords
    venous thromboembolism; hip fractures; low molecular weight heparin

    Figures

    Figure 1
    Flow chart of patient enrollment.

    Figure 2
    Independent risk factors for thromboembolism in patients with hip fractures. BMI, body mass index; DVT, deep vein thrombosis; fx, fracture; ASA, American Society of Anesthesiologists; EBL, estimated blood loss; Group A, postoperative enoxaparin; OR, odds ratio.

    Tables

    Table 1
    Patient Baseline Characteristics

    Table 2
    Incidence of Symptomatic VTE during Hospitalization

    Table 3
    Safety Outcomes

    Table 4
    Hematologic Trends

    Notes

    This research was supported by grant from Pusan National University Hospital, 2016.

    CONFLICTS OF INTEREST:The authors have nothing to disclose.

    References

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    MeSH Terms
    Aged
    Busan
    Enoxaparin*
    Hemorrhage
    Heparin, Low-Molecular-Weight
    Hip Fractures
    Hip*
    Hospitalization
    Humans
    Incidence
    Odds Ratio
    Pulmonary Embolism
    Risk Factors
    Venous Thromboembolism
    Venous Thrombosis
    Metrics
    Share
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