Venous Thromboembolism in Hip Fracture Patients: A Subanalysis of the FAITH and HEALTH Trials.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
entrez:
7
10
2020
pubmed:
8
10
2020
medline:
22
6
2021
Statut:
ppublish
Résumé
The primary objective of this study was to determine the incidence of symptomatic venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), in the hip fracture population. Secondary objectives included determining timing of VTE diagnosis, VTE thromboprophylaxis given, and identifying any factors associated with VTE. Using data from the FAITH and HEALTH trials, the incidence of VTE, including DVT and PE, and the timing of VTE were determined. A multivariable Cox regression analysis was used to determine which factors were associated with increased risk of VTE, including age, treatment for comorbidity, thromboprophylaxis, time to surgery, and method of fracture management. 2520 hip fracture patients were included in the analysis. Sixty-four patients (2.5%) had a VTE [DVT: 36 (1.4%), PE: 28 (1.1%)]. Thirty-five (54.7%) were diagnosed less than 6 weeks postfracture and 29 (45.3%) more than 6 weeks postfracture. One thousand nine hundred ninety-three (79%) patients received thromboprophylaxis preoperatively and 2502 (99%) received thromboprophylaxis postoperatively. The most common method of preoperative (46%) and postoperative (73%) thromboprophylaxis was low molecular weight heparin. Treatment with arthroplasty compared to internal fixation was the only variable associated with increased risk of VTE (hazard ratio 2.67, P = 0.02). The incidence of symptomatic VTE in hip fracture patients recruited to the 2 trials was 2.5%. Although over half of the cases were diagnosed within 6 weeks of fracture, VTE is still prevalent after this period. The majority of patients received thromboprophylaxis. Treatment with arthroplasty rather than fixation was associated with increased incidence of VTE. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
The primary objective of this study was to determine the incidence of symptomatic venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), in the hip fracture population. Secondary objectives included determining timing of VTE diagnosis, VTE thromboprophylaxis given, and identifying any factors associated with VTE.
METHODS
Using data from the FAITH and HEALTH trials, the incidence of VTE, including DVT and PE, and the timing of VTE were determined. A multivariable Cox regression analysis was used to determine which factors were associated with increased risk of VTE, including age, treatment for comorbidity, thromboprophylaxis, time to surgery, and method of fracture management.
RESULTS
2520 hip fracture patients were included in the analysis. Sixty-four patients (2.5%) had a VTE [DVT: 36 (1.4%), PE: 28 (1.1%)]. Thirty-five (54.7%) were diagnosed less than 6 weeks postfracture and 29 (45.3%) more than 6 weeks postfracture. One thousand nine hundred ninety-three (79%) patients received thromboprophylaxis preoperatively and 2502 (99%) received thromboprophylaxis postoperatively. The most common method of preoperative (46%) and postoperative (73%) thromboprophylaxis was low molecular weight heparin. Treatment with arthroplasty compared to internal fixation was the only variable associated with increased risk of VTE (hazard ratio 2.67, P = 0.02).
CONCLUSIONS
The incidence of symptomatic VTE in hip fracture patients recruited to the 2 trials was 2.5%. Although over half of the cases were diagnosed within 6 weeks of fracture, VTE is still prevalent after this period. The majority of patients received thromboprophylaxis. Treatment with arthroplasty rather than fixation was associated with increased incidence of VTE.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 33027169
doi: 10.1097/BOT.0000000000001939
doi:
Substances chimiques
Anticoagulants
0
Heparin, Low-Molecular-Weight
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
S70-S75Investigateurs
Mohit Bhandari
(M)
Marc Swiontkowski
(M)
P J Devereaux
(PJ)
Gordon Guyatt
(G)
Martin J Heetveld
(MJ)
Kyle Jeray
(K)
Susan Liew
(S)
Martin Richardson
(M)
Emil H Schemitsch
(EH)
Lehana Thabane
(L)
Paul Tornetta
(P)
Stephen D Walter
(SD)
Mohit Bhandari
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Sheila Sprague
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Paula McKay
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Taryn Scott
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Helena Viveiros
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Marilyn Swinton
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Mark Gichuru
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Qi Zhou
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Deborah Maddock
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Nicole Simunovic
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Marc Swiontkowski
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Martin J Heetveld
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Jani Knifsund
(J)
Keijo Mäkelä
(K)
Keemu Hannes
(K)
Mikko Karvonen
(M)
Saara Meronen
(S)
William Farrington
(W)
Rob Sharp
(R)
Otis Shirley
(O)
Luke Brunton
(L)
Marla Ross
(M)
Sherina Holland
(S)
Rian Smit
(R)
Leonard Marais
(L)
Simphiwe Gumede
(S)
Reitze Rodseth
(R)
Références
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