DOS 2016

DOS Kongressen 2016 ·

Thrombosis after hip fracture surgery

Liv Riisager Wahlsten, Henrik Palm, Jonas Olesen, Gunnar Gislason,

Stig Brorson

Department of Orthopaedics, Copenhagen University Hospital Herlev; Hip

Fracture Unit, Department of Orthopaedics, Copenhagen University Hospital

Hvidovre; Cardiovascular Research Center, Copenhagen University Hospital

Gentofte; Cardiovascular Research Center, Copenhagen University Hospital

Gentofte; Department of Orthopaedics, Copenhagen University Hospital Herlev

Background:

Thromboembolism is a serious complication after hip fracture

surgery. Antithrombotic prophylaxis guidelines have been debated and based

on literature now recommend treatment 10 days post-op for all hip fracture

patients. If thrombosis risk factors are identified, future antithrombotic prophy-

laxis guidelines could however be individualized.

Purpose / Aim of Study:

To determine event rates, temporal patterns, and risk

factors of clinical significant thromboembolic complications after hip fracture

surgery; including venous thromboembolism (VTE), myocardial infarction (MI),

stroke, and all-cause mortality.

Materials and Methods:

All Danish citizens aged ≥50 years surviving until dis-

charge after surgery for hip fractures between 1999 and 2012 were included in

this national cohort study. Data was obtained from the national administrative

databases. Cox regression models were used to identify covariates associated

with an event.

Findings / Results:

We included 98,212 patients surviving surgery for a hip

fracture. During 1-year of follow-up, VTE occurred in 1.66%, MI in 1.92%, and

stroke in 4.03%, mortality was 29%. The event rate was highest in the begin-

ning of the follow-up period, and the median time to an event was 28 days for

VTE, 11 days for MI, and 22 days for stroke. The strongest risk factor of any

thromboembolic complication was having a previous history of the event, lead-

ing to hazard ratios at 3.6 (CI 2.8-4.5) for previous VTE, 7.5 (CI 7.1-8.0) for

previous MI, and 4.9 (CI 4.4-5.4) for previous stroke.

Conclusions:

Thromboembolism seems to occur early after hip fracture sur-

gery. Also it appears possible to identify patients at high risk, which indicates the

possibility of future more individualized antithrombotic prophylaxis guidelines.

No conflicts of interest reported

28.