Anticoagulation therapy and proximal femoral fracture treatment

Approximately 77 000 proximal hip fractures occur in the United Kingdom annually, accounting for 1.5 million beddays, at an inpatient cost of £2 billion.1,2 The majority of them (65 000) occur in England, with a median post-operative length of stay (LOS) of 23 days and a 30-day mortality of between approximately 8% and 10% which has remained constant for the last two decades.2 The majority (95%) of hip fractures occur in patients over the age of 60 years, 75% of which occur in females.1,2 More than 98% of fractures are treated surgically in order to reduce the risk of development of complications (pneumonia, pressure sores, deep vein thrombosis, respiratory insufficiency, etc) and to facilitate early mobilisation and prompt hospital discharge. It is of note that 25% of patients with hip fractures have at least moderate cognitive impairment (abbreviated mental test score less than 7), 20% are institutionalised and 50% require walking aids or are immobile.1,2 One of the major post-surgical complications following hip fracture surgery is the development of deep vein thrombosis (DVT) and pulmonary embolism (PE).1 The incidence of DVT has been reported to be between 1% and 3% approximately, whereas PE is in the region of 0.5% and 3%.3 Nonetheless, DVT occurs in approximately 37% of patients with hip fracture and pulmonary embolism in 6%; these figures are derived from research studies employing venograms or VQ scans in a large cohort of patients, therefore representing the true incidence of asymptomatic events.3 It is of interest that clinicians managing this cohort of patients usually have to deal with two possible case scenarios: patients presenting with no current intake of anticoagulation therapy; and patients who are already taking anticoagulation drugs for pre-existing medical conditions. The aim of this study is to report on the available protocols for prevention of thromboembolic events in patients admitted with proximal femoral fractures who are not receiving any anticoagulation therapy, and to investigate current trends of patients who are already on treatment for pre-existing medical conditions.