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Chemoprophylaxis for the Hip Fracture Patient

A Comparison of Warfarin and Low-Molecular-Weight Heparin

Trivedi, Nikunj N., MD*; Sivasundaram, Lakshmanan, MD*; Wang, Christopher, BS; Kim, Chang Y., MD*; Buser, Zorica, PhD; Wang, Jeffrey C., MD; Ochenjele, George, MD*

Journal of Orthopaedic Trauma: May 2019 - Volume 33 - Issue 5 - p 216–219
doi: 10.1097/BOT.0000000000001435
Original Article
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Objective: To compare the rates of deep venous thrombosis (DVT), rates of pulmonary embolus (PE), and complication profiles of warfarin and low-molecular-weight heparin (LMWH) in patients undergoing operative fixation of hip fractures.

Design: Retrospective cohort study.

Setting: Insurance-based database of more than 22 million patient records.

Patients: Adult hip fracture patients who were treated operatively and received chemoprophylaxis from 2007 to 2016. A total of 7594 patients met inclusion criteria and were available for final analysis.

Intervention: Pharmacological anticoagulation with warfarin or LMWH to prevent postoperative venous thromboembolism after hip fracture surgery.

Main Outcome Measures: Development of DVT or PE within 30 and 90 days of surgery.

Results: Patients prescribed warfarin had higher rates of DVT and PE compared with those prescribed LMWH. Patients on warfarin were more likely to develop a postoperative hematoma and to be readmitted within 30 and 90 days compared with those on LMWH. Patients in both groups had similar rates of total complications.

Conclusions: Patients prescribed warfarin after hip fractures had higher rates of DVT and PE compared with those prescribed LMWH, although both agents had similar complication profiles.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; and

Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Reprints: Nikunj N. Trivedi, MD, Department of Orthopaedic Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5043 (e-mail: nikunj.trivedi@uhhospitals.org).

The authors report no conflict of interest.

Presented in part at the Annual Meeting of the American Academy of Orthopaedic Surgeons, March 8, 2018, New Orleans, LA.

Accepted December 28, 2018

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