Transfusion and Haemostasis
Background and Goal of Study: Snapshot on hip fracture to measure the incidence and the predictive risk factors for clinical venous thromboembolic events (VTE), to describe the use of antithrombotic prophylaxis and to measure mortality and its predictive risk factors after 6 months.
Materials and Methods: Prospective, multicenter (n = 525) epidemiological study. Inclusion of operated hip fracture patients between October 1st and November 30, 2002. VTE were assessed by a critical events committee. Risk factors were isolated using a logistic regression. Odds Ratio - Cl 95%.
Results and Discussions: 7019 patients were included among which 6860 (97.7%) were analysed: age 81 ± 12 (76% women, 63% > 80yr), history of cardio-vascular disease 63%, history of deep vein thrombosis (DVT) or pulmonary embolism (PE) 6.4%. Surgery was performed with general anaesthesia 56%, (among which regional + general 7%) and regional 44%. A low molecular weight heparin (LMWH) treatment was initiated pre-operatively in 51% of the patients. The median prophylaxis duration was 6 weeks. At 3 months, 75 symptomatic and confirmed DVTs and 15 PEs were reported in 85 patients (global rate 1.3% (Cl 1.1%-1.6%). Fatal PE rate was 0.3%. Positive predictive risk factors: history of DVT or PE (OR 2.5 (1.6-4.0)), interval between the induction of anaesthesia and arrival in the recovery room greater than 2 hrs (OR 2.2 (1.4-3.4)). The LMWH treatment was beneficial (OR 0.3 (0.1-0.8)). After 6 months, 1066 patients died (14,7%) among which 366 died during the first month. The main causes were cardiac (31%), neurological (20%) pulmonary infections (8%), other causes (38%) and 49 (4.1%) deaths were declared as possible or definite PE. Major bleeding occurred in 86 (1.2%) patients (16 deaths). The main mortality predictive risk factors were: age, gender, reduced preoperative autonomy and cognitive functions, and complications requiring a re-hospitalisation. The use of regional anaesthesia (peripheral blocks 99%) combined with general anaesthesia was beneficial (OR 0.6 (0.4-0.9)).
Conclusion(s): This very large study demonstrates that LMWH prophylaxis is applied widely after hip fracture in France and provides a high level of efficacy and safety. However the high death rate should lead to a major change in the care of these patients.