Key result
Adopting low-molecular-weight heparin in place of aspirin for routine thromboprophylaxis after hip fracture significantly reduced the rate of clinical DVT from 1.62% to 0.83% (P<0.05).
Why the study?
In 2010, NICE recommended anticoagulants over aspirin for thromboprophylaxis after hip fracture, prompting this evaluation of the impact of implementing that guidance on deep vein thrombosis incidence.
Does low-molecular-weight heparin reduce the incidence of deep vein thrombosis compared to aspirin in patients with hip fracture?
Cohort (n=5,039)
No
Does low-molecular-weight heparin reduce the incidence of deep vein thrombosis compared to aspirin in patients with hip fracture?
Switching from aspirin to LMWH for routine thromboprophylaxis after hip fracture halved the clinical incidence of DVT, supporting current NICE guidelines.
May reduce DVT after hip fracture; leaves open whether guidance change drove the effect in this retrospective analysis.
PURPOSE OF THE STUDY: In 2010, the National Institute for Health and Care Excellence (NICE) recommended the use of anticoagulants rather than aspirin as pharmacological thromboprophylaxis after hip fracture. We examine the impact of implementing this change in guidance on the clinical incidence of deep vein thrombosis (DVT). STUDY DESIGN: Demographic, radiographic and clinical data were retrospectively collected for 5039 patients admitted to a single tertiary centre in the UK for hip fracture between 2007 and 2017. We calculated rates of lower-limb DVT and examined the impact of the June 2010 change of departmental policy, from use of aspirin to use of low-molecular-weight heparins (LMWH) in hip fracture patients. RESULTS: Doppler scans were performed in 400 patients in the 180 days after a hip fracture, and identified 40 ipsilateral and 14 contralateral DVTs (p<0.001). The rate of DVT reduced significantly following the 2010 change in departmental policy from aspirin to LMWH in these patients (1.62% vs 0.83%, p<0.05). CONCLUSIONS: The rate of clinical DVT halved following the change from aspirin to LMWH for pharmacological thromboprophylaxis, but the number needed to treat was 127. A figure of <1% for the incidence of clinical DVT in a unit that routinely uses LMWH monotherapy following hip fracture provides a context for discussions of alternative strategies, and for power calculations for future research. These figures are important to policy makers and to researchers as they will inform the design of the comparative studies on thromboprophylaxis agents for which NICE has called.
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Poacher et al. (2022) conducted a cohort in hip fracture (n=5,039). Low-molecular-weight heparin (LMWH) vs. Aspirin was evaluated on clinical incidence of deep vein thrombosis (DVT) (NNT 127, p=<0.05). Adopting low-molecular-weight heparin in place of aspirin for routine thromboprophylaxis after hip fracture significantly reduced the rate of clinical DVT from 1.62% to 0.83% (P<0.05).
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