Given the significant established risk factors for VTE present in this patient population including age, presence of hip fracture, major surgery, delays to surgery, and the potential serious consequences of failure to provide prophylaxis in the hip fracture population, it is the recommendation of the workgroup that VTE prophylaxis be used
Risks and Harms of Implementing this Recommendation
Patients with hip fracture are at high risk for deep venous thrombosis and pulmonary embolism. The consequences of symptomatic VTE are significant and include both increased morbidity and mortality. The harms associated with this recommendation include those associated with VTE prophylaxis, bleeding and thrombotic complications.
The issue of VTE prophylaxis in patients who have sustained a hip fracture is complex. There are many unanswered questions that have the potential to have a significant impact on clinical outcomes for this patient population. A multi-armed randomized controlled study would be optimal. Such a study would potentially need to evaluate the comparative effectiveness of a multitude of chemical agents, at different dosages, with multiple time points (such as pre and post-op), and include assorted durations of therapy, while utilizing contemporary diagnostic methodologies. Barriers to such a study include the low incidence of the complication implicating a requirement for a substantially large sample size. Furthermore, such a study carries ethical concerns given the potential risks associated with under-treatment. Potentially, well organized patient outcome registries may ultimately help improve our knowledge in this area.
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