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

Nam Hoon Moon; Jae-Hoon Jang; Jin Sup Park; Ki Young Park; Young Gun Park

doi:10.4055/jkoa.2016.51.5.378

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Moon, Jang, Park, Park, and Park: Preoperative Enoxaparin versus Postoperative Enoxaparin Thromboprophylaxis in Hip Fracture Surgery: Is Preoperative Enoxaparin Safe to Use?

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(5): 378-386.

Published online: 26 October 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.5.378

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., 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, ansskagns@daum.net

Received 7 April 2016 Revised 3 May 2016 Accepted 1 June 2016

(open-access):

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 and Tables

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.

Table 1

Patient Baseline Characteristics

Values are presented as mean±standard deviation (range) or number (%). ^*Postoperative enoxaparin. ^†Same regimen with the addition of preoperative enoxaparin. BMI, body mass index; VTE, venous thromboembolism; ASA, American Society of Anesthesiologists.

Table 2

Incidence of Symptomatic VTE during Hospitalization

Values are presented as number (%) or median (range). ^*Postoperative enoxaparin. ^†Same regimen with the addition of preoperative enoxaparin. VTE, venous thromboembolism; OR, odds ratio; CI, confidence interval; DVT, deep vein thrombosis; PE, pulmonary embolism; N/A, not available.

Table 3

Safety Outcomes

Values are presented as number (%) or mean±standard deviation (range). ^*Postoperative enoxaparin. ^†Same regimen with the addition of preoperative enoxaparin.

Table 4

Hematologic Trends

Values are presented as mean±standard deviation (range). ^*Postoperative enoxaparin. ^†Same regimen with the addition of preoperative enoxaparin. INR, international normalized ratio; Hb, hemoglobin; POD, postoperative day; Hct, hematocrit.

Notes

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

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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