VTE Prophylaxis After Traumatic Hip Fracture Surgery
Lovenox (enoxaparin) 30 mg every 12 hours for 28-35 days is the most appropriate VTE prophylaxis for this patient with a recent traumatic right hip fracture who underwent open reduction with internal fixation. 1
Rationale for LMWH Prophylaxis
- Hip fracture patients should receive VTE prophylaxis as they are at high risk for thromboembolism (strong strength of evidence, strong strength recommendation) 1
- For patients with hip fractures, VTE prophylaxis should be continued for at least 28-35 days post-operatively 1
- Low-molecular-weight heparin (LMWH) is preferred for orthopedic surgery patients with the first dose given at least 12 hours from the time of surgery 1
- For orthopedic surgery patients, enoxaparin 30 mg twice daily is the recommended dosing regimen 1
Duration of Prophylaxis
- A minimum duration of 10-14 days of thromboprophylaxis is recommended for orthopedic surgery patients, with consideration of up to 35 days for patients at higher risk for VTE (grade 2B) 1
- Hip fracture patients are considered high risk and typically warrant extended prophylaxis 1, 2
- The AAOS guideline specifically mentions administering Lovenox for 4 weeks (28 days) postoperatively in hip fracture patients 1
Comparison of Options
Lovenox 30 mg every 12 hours for 28 days
- Aligns with current guidelines for hip fracture patients 1
- Provides appropriate duration and dosing for high-risk orthopedic patients 1
- Has strong evidence supporting its efficacy in preventing VTE in hip fracture patients 1
Therapeutic warfarin for 28 days
- Not recommended as first-line prophylaxis for orthopedic surgery patients 1
- Requires frequent monitoring and dose adjustments 1
- Has less predictable anticoagulation effect compared to LMWH 1
Lovenox 30 mg every 12 hours for 14 days
- Duration is insufficient for high-risk hip fracture patients 1
- Guidelines recommend at least 28-35 days of prophylaxis for hip fracture patients 1
Rivaroxaban 10 mg daily for 5 days followed by aspirin 325 mg for 30 days
- Rivaroxaban is approved for VTE prophylaxis after hip replacement but not specifically for traumatic hip fractures 3
- The 5-day duration is insufficient according to guidelines 1
- Aspirin alone is not recommended as sole VTE prophylaxis for hip fracture patients 2
- This combination regimen is not supported by current guidelines 1
Special Considerations
- The patient has no contraindications to LMWH (no history of bleeding disorders or medication allergies) 1
- The patient's comorbidities (hypertension and hypothyroidism) do not contraindicate LMWH use 1
- Current outpatient medications (amlodipine and levothyroxine) do not have significant interactions with LMWH 1
Potential Pitfalls
- Inadequate duration of prophylaxis is a common error in VTE prevention after hip fracture surgery 1
- Under-prophylaxis increases risk of symptomatic VTE and mortality 2
- Mechanical prophylaxis alone is insufficient for hip fracture patients unless there are contraindications to pharmacological prophylaxis 1
- Aspirin alone provides suboptimal protection compared to other chemical agents and is not recommended as sole prophylaxis 2