VPB1373 - Pre-Operative Thromboprophylaxis Does Not Cause Increased Bleeding Events in Patients with Surgically-Treated Hip Fractures

Background: Current guidelines recommend pre-operative initiation of thromboprophylaxis if surgery for hip fracture is delayed for more than 12 hours to prevent post-operative VTE. Yet, thromboprophylaxis is often not administered due to concerns regarding increased peri-operative bleeding. Recent studies have found conflicting evidence on this topic.

Aims: The purpose of this study was to determine usage rates of pre-operative thromboprophylaxis in this patient population and to compare the complication rate between patients who received and did not receive pre-operative thromboprophylaxis following hip fracture surgery.

Methods: A prospective cohort (REB16-2240) of patients over 50 years of age with hip fractures amenable to surgical treatment were recruited at a Level I trauma centre. Pre-operative thromboprophylaxis was administered at the discretion of the surgical team. All patients received 28 days of thromboprophylaxis post-operatively with low-molecular-weight-heparin. Major and clinically relevant non-major bleeding was based on International Society on Thrombosis and Haemostasis definitions. Standardized z-scores and two-sample t-tests were used to compare outcomes.

Results: Of the 121 patients included in this study, 31 (25.6%) were given pre-operative thromboprophylaxis. No significant differences were found between patients who received and did not receive pre-operative thromboprophylaxis in terms of demographics, comorbidities, fracture type, or surgical procedure. Patients who were given pre-operative thromboprophylaxis did not experience increased peri-operative bleeding, but did have significantly longer time to surgery (p=0.02), longer surgical duration (p=0.03), and increased 3-month mortality (p=0.02) (Table 1).

Conclusion(s): Patients who were given pre-operative thromboprophylaxis did not experience increased peri-operative bleeding or VTE events; however, further research is needed to confirm these findings. The increased 3-month mortality experienced in these patients may be attributed to pre-fracture comorbidities, prolonged time to surgery, and duration of the operation.