From the FDA Drug Label
In patients undergoing hip fracture surgery, the recommended dose of fondaparinux sodium injection is 2.5 mg administered by subcutaneous injection once daily after hemostasis has been established. In patients undergoing hip fracture surgery, an extended prophylaxis course of up to 24 additional days is recommended.
The recommended thromboprophylaxis in patients with thrombophilia (blood clotting disorder) and fractures is fondaparinux sodium injection 2.5 mg administered by subcutaneous injection once daily after hemostasis has been established, with an extended prophylaxis course of up to 24 additional days in patients undergoing hip fracture surgery 1.
From the Research
Patients with thrombophilia who sustain fractures should receive aspirin as thromboprophylaxis, as it has been shown to be noninferior to low-molecular-weight heparin in preventing death and is associated with low incidences of deep-vein thrombosis and pulmonary embolism, according to the most recent and highest quality study 2. The recommended dose of aspirin is 81 mg twice daily, which can be started as soon as hemostasis is achieved, typically within 24 hours post-injury or surgery.
- The duration of thromboprophylaxis should continue until the patient regains full mobility or for a minimum of 2-6 weeks for lower extremity fractures.
- For patients with severe thrombophilia, therapeutic anticoagulation may be warranted, but the use of aspirin as thromboprophylaxis has been shown to be effective in reducing the risk of VTE.
- Mechanical prophylaxis with intermittent pneumatic compression devices can be used in conjunction with pharmacological methods, especially when anticoagulation is temporarily contraindicated.
- Early mobilization should be encouraged as soon as clinically appropriate to reduce the risk of VTE. The use of aspirin as thromboprophylaxis is supported by the study published in The New England Journal of Medicine, which found that aspirin was noninferior to low-molecular-weight heparin in preventing death and was associated with low incidences of deep-vein thrombosis and pulmonary embolism 2. While other studies have suggested the use of low-molecular-weight heparin or direct oral anticoagulants as thromboprophylaxis, the most recent and highest quality study supports the use of aspirin 2. It is essential to note that the management of thrombophilia and VTE risk should be individualized, and the use of aspirin as thromboprophylaxis should be based on the patient's specific risk factors and medical history.