Hip Fracture and Venous Thromboembolism in the Elderly

Venous thromboembolism (VTE), a highly prevalent vascular disorder, is frequently clinically silent, and is often difficult to diagnose. VTE consists of both deep vein thrombosis (DVT) and pulmonary embolism (PE), both of which are associated with potentially significant morbidity and mortality. With the availability of safe and effective antithrombotic therapy, the standard of medical care should be the routine use of thromboprophylaxis. The risk of developing VTE increases with advancing age, and the performance of surgery to repair a fractured hip increases this risk even more. Thus elderly hip fracture patients are always considered to be at the highest risk for developing fatal PE. Over the last decade, new anticoagulants, such as the factor Xa inhibitor fondaparinux, have been developed that specifically target individual components of the coagulation system. Fondaparinux is a selective, synthetic factor Xa inhibitor that has been shown to significantly reduce the risk of VTE versus enoxaparin in patients undergoing surgery for hip fracture. Extended (4-week) prophylaxis with fondaparinux can produce a 96% reduction in risk of DVT and an 89% reduction in risk of symptomatic VTE events relative to perioperative (1-week) prophylaxis. As the only anticoagulant approved in the United States for thromboprophylaxis in hip fracture patients, fondaparinux offers more effective prophylaxis against VTE without compromising safety. (Journal of Surgical Orthopaedic Advances 13(3):139–148, 2004)