From the Guidelines
DVT prophylaxis for hip fracture patients should begin as soon as possible and continue for at least 28-35 days post-surgery, with low molecular weight heparin (LMWH) being the preferred medication option, as evidenced by the most recent study 1. The management of hip fracture patients requires careful consideration of the risk of venous thromboembolism (VTE), which can be reduced with appropriate prophylaxis.
- The risk of VTE is elevated in hip fracture patients due to the combination of trauma, immobility, surgery, and often advanced age with comorbidities.
- The American College of Chest Physicians (ACCP) and International Union of Angiology (IUA) guidelines recommend LMWH as the preferred medication option for DVT prophylaxis in hip fracture patients 1.
- A recent study published in the World Journal of Emergency Surgery in 2024 found that LMWH is more effective than unfractionated heparin (UFH) in preventing DVT, with a relative risk (RR) of 0.68 1.
- Another study found that the association of mechanical and pharmacological prophylaxis further decreases the risk of DVT, with a RR of 0.34 1.
- The choice of medication should be based on the patient's individual risk factors, including bleeding risk, renal function, and patient preference.
- Mechanical prophylaxis with intermittent pneumatic compression devices should be used in patients with contraindications to anticoagulation.
- Early mobilization should be implemented for all patients as soon as feasible after surgery to reduce the risk of VTE.
- Renal function should be monitored and medication doses adjusted accordingly, especially for enoxaparin and fondaparinux.
- Patients should be assessed for bleeding risk before initiating pharmacological prophylaxis, and those with active bleeding or high bleeding risk may need to rely on mechanical methods initially. Some key points to consider when selecting a medication for DVT prophylaxis in hip fracture patients include:
- The effectiveness of the medication in preventing DVT
- The risk of bleeding associated with the medication
- The patient's individual risk factors, including renal function and bleeding risk
- The patient's preference and ability to adhere to the medication regimen
- The cost and availability of the medication. In terms of specific medication options, LMWH such as enoxaparin 40mg subcutaneously once daily, fondaparinux 2.5mg subcutaneously once daily, or direct oral anticoagulants (DOACs) like rivaroxaban 10mg orally once daily or apixaban 2.5mg orally twice daily may be considered 1.
From the FDA Drug Label
In patients undergoing hip fracture, hip replacement, or knee replacement surgery, the recommended dose of fondaparinux sodium injection is 2.5 mg administered by subcutaneous injection once daily after hemostasis has been established. Administer the initial dose no earlier than 6 to 8 hours after surgery. In patients undergoing hip fracture surgery, an extended prophylaxis course of up to 24 additional days is recommended.
DVT Prophylaxis in Hip Fracture: Fondaparinux sodium injection is indicated for the prophylaxis of deep vein thrombosis (DVT) in patients undergoing hip fracture surgery. The recommended dose is 2.5 mg administered by subcutaneous injection once daily, starting 6 to 8 hours after surgery. An extended prophylaxis course of up to 24 additional days is recommended in patients undergoing hip fracture surgery 2.
From the Research
DVT Prophylaxis in Hip Fracture
- The use of low-molecular-weight heparin (LMWH) for DVT prophylaxis in hip fracture patients has been studied extensively 3, 4, 5, 6, 7.
- A study published in 2001 found that thromboprophylaxis with 60 mg enoxaparin daily, in split doses, starting before surgery, is safe and appropriate in patients with hip fractures, with a low incidence of clinically apparent DVT and PE 3.
- Another study published in 2010 reviewed the current evidence on VTE prophylaxis for patients with hip fractures and found that LMWH, fondaparinux, warfarin, and unfractionated heparin reduce the risk of venographic deep vein thrombosis, but there is insufficient evidence that they reduce fatal pulmonary embolism or all-cause mortality 4.
- A randomized open trial published in 1992 compared the antithrombotic efficacy of LMWH with that of dextran 70 in patients undergoing surgery for hip fracture and found that LMWH has a significantly better thromboprophylactic effect than dextran 70 5.
- A review published in 2004 discussed the use of LMWH in the treatment of thrombosis and found that LMWHs are an effective and safe alternative for treatment of deep vein thrombosis and venous thromboembolism 6.
- A recent study published in 2025 found that DVT occurs in 24% of patients after hip fracture surgery despite thromboprophylaxis, and that time to surgery and ≥2 comorbidities were independent risk factors for DVT 7.
Types of Prophylaxis
- LMWH, such as enoxaparin, dalteparin, and nadroparin, are commonly used for DVT prophylaxis in hip fracture patients 3, 4, 5, 6, 7.
- Fondaparinux, warfarin, and unfractionated heparin are also used for VTE prophylaxis in hip fracture patients 4.
- Mechanical devices, such as compression stockings and intermittent pneumatic compression, are also used for VTE prophylaxis, but are not recommended for sole use due to poor patient compliance 4.
- Aspirin is not recommended for sole VTE prophylaxis due to its limited efficacy compared to other chemical agents 4.
Efficacy and Safety
- The efficacy and safety of LMWH for DVT prophylaxis in hip fracture patients have been established in several studies 3, 4, 5, 6, 7.
- LMWH has been found to be an effective and safe alternative for treatment of deep vein thrombosis and venous thromboembolism 6.
- The use of LMWH has been found to reduce the risk of venographic deep vein thrombosis, but there is insufficient evidence that it reduces fatal pulmonary embolism or all-cause mortality 4.
- The safety of LMWH has been established, with a low risk of major bleeding complications 3, 5, 6.