NDLI: Low-molecular-weight heparin for hip fracture patients treated with osteosynthesis: should thromboprophylaxis start before or after surgery? An observational study of 45,913 hip fractures reported to the Norwegian Hip Fracture Register

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Time of admission and mortality after hip fracture: a detailed look at the weekend effect in a nationwide study of 55,211 hip fracture patients in Norway

Low-molecular-weight heparin for hip fracture patients treated with osteosynthesis: should thromboprophylaxis start before or after surgery? An observational study of 45,913 hip fractures reported to the Norwegian Hip Fracture Register

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Low-molecular-weight heparin for hip fracture patients treated with osteosynthesis: should thromboprophylaxis start before or after surgery? An observational study of 45,913 hip fractures reported to the Norwegian Hip Fracture Register

Content Provider	Taylor & Francis Online
Author	Gjertsen, Jan-Erik Dybvik, Eva Engesaeter, Lars B. Leer-Salvesen, Sunniva Dahl, Ola E.
Abstract	Background and purpose — Controversies exist regarding thromboprophylaxis in orthopedic surgery. We studied whether the thromboprophylaxis in hip fracture patients treated with osteosynthesis should start preoperatively or postoperatively. Data were extracted from the nationwide Norwegian Hip Fracture Register (NHFR). The risks of postoperative deaths, reoperations, and intraoperative bleeding were studied within 6 months after surgery.Patients and methods — After each operation for hip fracture in Norway the surgeon reports information on the patient, the fracture, and the operation to the NHFR. Cox regression analyses were performed with adjustments for age group, ASA score, sex, duration of surgery, and year of surgery. During the period 2005–2016, 96,599 hip fractures were reported to the register. Only osteosyntheses where low-molecular-weight heparin (LMWH) were given and with known information on preoperative start of the prophylaxis were included in the analyses. Dalteparin and enoxaparin were used in 58% and 42% of the operations respectively (n = 45,913).Results — Mortality (RR =1.01, 95% CI 0.97–1.06) and risk of reoperation (RR =0.99, CI 0.90–1.08) were similar comparing preoperative and postoperative start of LMWH. Postoperative start reduced the risk of intraoperative bleeding complications compared with preoperative start (RR =0.67, CI 0.51–0.90).Interpretation — The initiation of LMWH did not influence the mortality or the risk of reoperation in hip fracture patients treated with osteosynthesis. Postoperative start of LMWH could possibly decrease the risk of intraoperative bleeding.
Starting Page	615
Ending Page	621
Page Count	7
File Format	PDF HTM / HTML
ISSN	17453674 17453682
DOI	10.1080/17453674.2018.1519101
Journal	Acta Orthopaedica
Volume Number	89
Issue Number	6
Language	English
Publisher	Taylor & Francis
Publisher Date	2018-10-17
Access Restriction	Open
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery

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