What is the recommended duration of Deep Vein Thrombosis (DVT) prophylaxis for patients with hip fractures?

Duration of DVT Prophylaxis for Hip Fracture

Extended prophylaxis for 32 days (5-9 days perioperative plus up to 24 additional days) is recommended for patients with hip fractures. 1

Recommended Prophylactic Regimens

First-Line Options:

• Fondaparinux (2.5 mg subcutaneously once daily)

  • Start 6-8 hours after surgery when hemostasis is established 1
  • Preferred agent according to ACCP guidelines 2
  • Demonstrated superior efficacy in hip fracture surgery 3

• Low Molecular Weight Heparin (LMWH)

  • Enoxaparin 40 mg once daily or 30 mg twice daily 2
  • Start 12 hours before surgery or 12-24 hours after surgery 2

Alternative Options:

• Aspirin (81 mg twice daily)
  • Recent evidence shows aspirin is non-inferior to LMWH for mortality prevention in fracture patients 4
  • Can be considered after initial 5 days of LMWH/fondaparinux 5

Duration Protocol

1. Initial (Perioperative) Phase:

   • 5-9 days of prophylaxis during hospitalization 2, 1
   • Start within appropriate timeframe after surgery based on agent selected

2. Extended Phase:

   • Continue for additional 24 days after hospital discharge 1
   • Total duration: 32 days (approximately 4-5 weeks) 1

Important Considerations

• Timing of first dose: Critical for safety

  • Fondaparinux: No earlier than 6-8 hours after surgery 1
  • LMWH: Typically 12-24 hours after surgery 2
  • Earlier administration increases major bleeding risk 1

• Renal function:

  • Fondaparinux is contraindicated in severe renal insufficiency (CrCl <30 mL/min) 2
  • Use caution with fondaparinux in moderate renal dysfunction (CrCl 30-50 mL/min) 2

• Mechanical prophylaxis:

  • Thromboembolism stockings or intermittent compression devices should be used intraoperatively 2
  • Can be used as sole prophylaxis in patients at high risk of bleeding 2

Rationale for Extended Prophylaxis

Hip fracture patients have a high risk of VTE with studies showing:

• 37% prevalence of DVT and 6% prevalence of PE on venogram/V/Q studies 2
• Extended prophylaxis provides additional reduction in VTE events without increasing bleeding risk 3

The FDA-approved label for fondaparinux specifically recommends extended prophylaxis up to 32 days total for hip fracture patients, making this the most evidence-based approach 1.