DVT Prophylaxis After Hip Hematoma Washout
DVT prophylaxis is strongly recommended after hematoma washout of the hip, with low molecular weight heparin (LMWH) as the preferred first-line option, starting 12-24 hours after surgery and continuing for 10-14 days, with consideration for extended prophylaxis up to 35 days. 1
Risk Assessment
Hip surgery patients, including those undergoing hematoma washout, are at high risk for venous thromboembolism (VTE) due to:
- Advanced age (especially >65 years)
- Reduced mobility
- Inflammatory state generated by trauma and surgical intervention
- The surgical procedure itself
Without prophylaxis, the incidence of DVT can reach 37% in patients with hip procedures 1.
Recommended Prophylactic Regimens
Pharmacological Options
First-line: Low Molecular Weight Heparin (LMWH)
- Enoxaparin 30 mg subcutaneously twice daily or 40 mg once daily
- Start 12-24 hours after surgery
- Continue for 10-14 days minimum 1
Alternative Options:
- Fondaparinux 2.5 mg once daily (contraindicated in severe renal impairment)
- Rivaroxaban 10 mg once daily (starting 6-10 hours after surgery)
- Unfractionated heparin 5000 U every 8 hours (primarily when LMWH is contraindicated or in patients with severe renal insufficiency) 1
LMWH is preferred over unfractionated heparin due to:
- Lower incidence of DVT and PE
- Fewer bleeding complications
- Less frequent dosing requirements 1
Mechanical Prophylaxis
Mechanical prophylaxis should be used in conjunction with pharmacological prophylaxis for optimal protection:
- Intermittent pneumatic compression devices (IPC)
- Graduated compression stockings
- Early mobilization when possible 1, 2
Duration of Prophylaxis
The American College of Chest Physicians and other guidelines recommend:
- Minimum of 7-10 days of prophylaxis 2, 3
- Extended prophylaxis (up to 35 days) for high-risk patients 1
The risk of VTE persists for up to 2-3 months following hip surgery, making extended prophylaxis particularly important in this population 1, 3.
Special Considerations
High Bleeding Risk
- For patients with high bleeding risk, mechanical prophylaxis alone may be used initially until the risk of bleeding decreases 1
- Once bleeding risk subsides, pharmacological prophylaxis should be initiated
Renal Impairment
- For patients with severe renal impairment (CrCl <30 mL/min), fondaparinux should be avoided
- Consider unfractionated heparin or reduced-dose LMWH 1
Elderly Patients
- For patients >65 years, consider Enoxaparin 30 mg every 12 hours
- For patients >75 years, use fondaparinux with caution 1
Monitoring and Follow-up
- Regular assessment for signs and symptoms of DVT (calf pain, swelling, warmth)
- Monitor for bleeding complications
- Ensure proper administration of mechanical prophylaxis if used
Conclusion
Following hematoma washout of the hip, patients should receive DVT prophylaxis with LMWH as the preferred agent, starting within 12-24 hours after surgery and continuing for at least 10-14 days. Extended prophylaxis up to 35 days should be considered, particularly for patients with additional risk factors for VTE. Mechanical prophylaxis should complement pharmacological methods for optimal protection.