Venous thromboembolism prophylaxis after surgery for hip fracture: A survey of physician practices

Introduction: Guidelines for thromboprophylaxis after hip fracture surgery suggest parenteral anticoagulants, based on low-certainty evidence. Emerging data suggest that direct oral anticoagulants (DOACs) or acetylsalicylic acid (ASA) might be safe and effective alternatives. We conducted a survey to inform the design of a randomized controlled trial (RCT) in this setting. Methods: We recruited a convenience sample of physicians who could prescribe thromboprophylaxis after hip fracture surgery. The survey was disseminated in Aug–Dec 2023. Participants answered 14 questions on demographics, current practices for thromboprophylaxis after hip fracture surgery, the need for an RCT on this topic, and acceptable interventions for a future RCT. Results: 204 participants from 28 countries completed the survey. Of these, 172 (84%, 95% CI 79%;89%) indicated the need for an RCT. Respondents reported using the following regimens: low-molecular-weight heparin (LMWH) alone (59%, 95% CI: 52%;66%), LMWH followed by rivaroxaban/apixaban (27%, 95% CI: 21%;33%), and rivaroxaban/apixaban without LMWH (25%, 95% CI: 19%;31%). LMWH or LMWH followed by rivaroxaban/apixaban were ranked highest among interventions to be tested in an RCT. Only 64 participants (31%, 95% CI: 25%;37%) were comfortable with ASA alone, and 82 (40%, 95% CI: 33%;47%) with ASA after a short course of anticoagulation. Conclusions: Among respondents, LMWH and DOACs were the most prescribed agents for thromboprophylaxis after hip fracture surgery. For an RCT, respondents were most comfortable with comparing LMWH with LMWH followed by rivaroxaban/apixaban.