Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Prevention of Venous Thromboembolism in Patients Undergoing Hip Fracture Surgery: A Survey of the Korean Hip Society

  • Chang Hyun Kim (Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan) ;
  • Je-Hyun Yoo (Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine) ;
  • Young-Kyun Lee (Department of Orthopedic Surgery, Seoul National University Bundang Hospital) ;
  • Ye-Yeon Won (Department of Orthopedic Surgery, Ajou University College of Medicine) ;
  • Jong-Seok Park (Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan)
  • Received : 2023.01.27
  • Accepted : 2023.04.24
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to assess the current status of venous thromboembolism (VTE) prevention in Korean patients with hip fractures. Materials and Methods: A survey using a questionnaire on the experiences and protocols of VTE prevention was conducted among 570 members of the Korean Hip Society. Results: A total of 97 surgeons responded, with a response rate of 17.0%. Of the 97 participants, 61.9% answered that they had encountered one or more cases of symptomatic VTE in the past year. Mechanical prophylaxis was applied most often (30.9%) until the point of ambulation in standard-risk patients and most often (34.0%) extended until discharge in high-risk patients. Chemical prophylaxis was most often prescribed for a particular period of time rather than for recovery of walking ability (24.7% in standard-risk patients and 26.8% in high-risk patients). Dual prophylaxis was administered in the standard-risk group by 58.8% of the participants and in the high-risk group by 83.5%. Among the participants, 73.2% answered that they had been attentive to wound complications during chemical prophylaxis. More than half of the participants (59.8%) reported that they did not perform routine screening for VTE after surgery. Conclusion: The results of our survey provided information regarding the current status of VTE prevention for patients undergoing surgery for treatment of hip fractures in Korea as well as a baseline for establishment of educational programs and guidelines in the future.

Keywords

Acknowledgement

This study was presented at the Fracture Symposium of the Korean Hip Society in November 2022.

References

  1. McLaughlin MA, Orosz GM, Magaziner J, et al. Preoperative status and risk of complications in patients with hip fracture. J Gen Intern Med. 2006;21:219-25. https://doi.org/10.1111/j.1525-1497.2006.00318.x
  2. Yhim HY, Jang MJ, Bang SM, et al. Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost. 2014;12:1035-43. https://doi.org/10.1111/jth.12611
  3. Shin WC, Woo SH, Lee SJ, Lee JS, Kim C, Suh KT.Preoperative prevalence of and risk factors for venous thromboembolism in patients with a hip fracture: an indirect multidetector CT venography study. J Bone Joint Surg Am. 2016;98:2089-95. https://doi.org/10.2106/JBJS.15.01329
  4. Kanchanabat B, Stapanavatr W, Meknavin S, Soorapanth C, Sumanasrethakul C, Kanchanasuttirak P. Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis. Br J Surg. 2011;98:1356-64. https://doi.org/10.1002/bjs.7589
  5. Park YS. Guideline for the prophylaxis of venous thromboembolism in hip surgery patients. J Korean Orthop Assoc. 2011;46:95-8. https://doi.org/10.4055/jkoa.2011.46.2.95
  6. Shin WC, Lee SM, Suh KT. Recent updates of the diagnosis and prevention of venous thromboembolism in patients with a hip fracture. Hip Pelvis. 2017;29:159-67. https://doi.org/10.5371/hp.2017.29.3.159
  7. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994;331:1601-6. https://doi.org/10.1056/NEJM199412153312401
  8. MacDonald DRW, Neilly D, Schneider PS, et al. Venous thromboembolism in hip fracture patients: a subanalysis of the FAITH and HEALTH trials. J Orthop Trauma. 2020;34 Suppl 3:S70-5. https://doi.org/10.1097/BOT.0000000000001939
  9. Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e278S-325S. https://doi.org/10.1378/chest.11-2404
  10. Hill J, Treasure T. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients having surgery: summary of NICE guidance. BMJ. 2007;334:1053-4. https://doi.org/10.1136/bmj.39174.678032.AD
  11. American Academy of Orthopaedic Surgeons (AAOS). Hip fractures in older adults. Clinical practice guideline on management of hip fractures in older adults [Internet]. Rosemont: AAOS; 2021 [cited 2023 Mar 15]. Available from: https://www.orthoguidelines.org/topic?id=1038&tab=all_guidelines
  12. Ngarmukos S, Kim KI, Wongsak S, et al. Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: part 1. Diagnosis and risk factors. Knee Surg Relat Res. 2021;33:18. https://doi.org/10.1186/s43019-021-00099-y
  13. Muscatelli SR, Charters MA, Hallstrom BR. Time for an update? A look at current guidelines for venous thromboembolism prophylaxis after hip and knee arthroplasty and hip fracture. Arthroplast Today. 2021;10:105-7. https://doi.org/10.1016/j.artd.2021.06.015
  14. Amarase C, Tanavalee A, Larbpaiboonpong V, et al. Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: part 2. Mechanical venous thromboembolism prophylaxis. Knee Surg Relat Res. 2021;33:20. https://doi.org/10.1186/s43019-021-00101-7
  15. Girasole GJ, Cuomo F, Denton JR, O'Connor D, Ernst A. Diagnosis of deep vein thrombosis in elderly hip-fracture patients by using the duplex scanning technique. Orthop Rev. 1994;23:411-6.
  16. Thiengwittayaporn S, Budhiparama N, Tanavalee C, et al. Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: part 3. Pharmacological venous thromboembolism prophylaxis. Knee Surg Relat Res. 2021;33:24. https://doi.org/10.1186/s43019-021-00100-8
  17. Garfinkel JH, Gladnick BP, Roland N, Romness DW. Increased incidence of bleeding and wound complications with FactorXa inhibitors after total joint arthroplasty. J Arthroplasty. 2018;33:533-6. https://doi.org/10.1016/j.arth.2017.08.039
  18. Mula V, Parikh S, Suresh S, Bottle A, Loeffler M, Alam M. Venous thromboembolism rates after hip and knee arthroplasty and hip fractures. BMC Musculoskelet Disord. 2020;21:95. https://doi.org/10.1186/s12891-020-3100-4
  19. Xiao C, Zhang S, Long N, Yu W, Jiang Y. Is intravenous tranexamic acid effective and safe during hip fracture surgery? An updated meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2019;139:893-902. https://doi.org/10.1007/s00402-019-03118-6
  20. Farrow LS, Smith TO, Ashcroft GP, Myint PK. A systematic review of tranexamic acid in hip fracture surgery. Br J Clin Pharmacol. 2016;82:1458-70. https://doi.org/10.1111/bcp.13079
  21. Markel DC, York S, Liston MJ Jr, Flynn JC, Barnes CL, Davis CM 3rd. Venous thromboembolism: management by American Association of Hip and Knee Surgeons. J Arthroplasty. 2010;25:3-9.e1-2. https://doi.org/10.1016/j.arth.2009.07.021