Postoperative Venous Thrombotic Events in Asian Elderly Patients with Surgically Treated Hip Fractures with and without Chemoprophylaxis

Abstract

Background and purpose Chemothromboprophylaxis for hip fracture surgery has been under-practiced in Asia. We investigate the postoperative incidence of venous thrombotic events (VTE) in elderly Asian patients with hip fractures. Patients and methods Patients over 60 years old with surgically treated hip fractures were reviewed. All patients followed a hip fracture protocol, which included a post-operative ultrasound Doppler venous scan of both lower limbs five days after injury to detect any deep vein thrombosis (DVT). All patients were given mechanical prophylaxis. Patients who had additional chemoprophylaxis were included. Results From 2010 to 2012, 454 patients were reviewed. The overall incidence of DVT was 6.4% (29 patients). The incidence of PE was 1.3% (six patients). There was no significant correlation between DVT and age, gender, race, hypertension, diabetes mellitus, end stage renal failure, type of fracture and operation, preoperative haemoglobin, platelet count or urea and creatinine levels. Sixteen DVTs (55.2%) were on the ipsilateral side as the fracture, eight (27.6%) were on the contralateral side and five (17.2%) were bilateral. Chemoprophylaxis was not given to 399 patients, of which 27 (6.8%) developed DVT. Ten (2.5%) were proximal DVTs in which four (1%) developed PE. One (0.25%) patient developed PE without DVT. Fifty-five patients were on chemoprophylaxis, of which two (3.6%) developed DVT. Both were proximal DVTs with one subsequently developing PE. Conclusions The incidence of VTE in Asian patients may be lower compared to Western populations when mechanical prophylaxis is used. Chemoprophylaxis may assist in reducing the rates of DVT but not PE. The low incidence may not justify the use of routine chemoprophylaxis.