Thromboprophylaxis with 60 mg enoxaparin is safe in hip trauma surgery

Background. Little information is available concerning dosage and optimal i nitiation of thromboprophylactic therapy with low-molecular-weight heparin (enoxaparin) in nonelective hip surgery. The aim of our prospective study w as to evaluate the incidence of clinically apparent deep vein thrombosis (D VT), pulmonary embolism (PE), and major hemorrhage in patients receiving th romboprophylaxis with enoxaparin undergoing hip surgery after hip fracture. Method. From 946 consecutive patients admitted with hip fractures, 897 were operated on and received enoxaparin according to the following regimen: Pr eoperative heparinization from time of admission onwards. Administration of 60 mg enoxaparin, in two doses (20 and 40 mg subcutaneously), during the f irst 5 days postoperatively. Prophylaxis for a minimum of 5 weeks (40 mg da ily). Results. Clinical signs of DVT were present in 37 patients (4.2%), who all underwent venography. In five patients, DVT was confirmed (0.6%). None of t hese patients suffered from PE. Another four patients (0.4%) developed clin ical signs of PE, and suspected diagnosis was confirmed by computed tomogra phic scan in two (0.2%). No deaths because of PE were observed. Major hemor rhage occurred in 42 patients (4.7%), there was one death from hemorrhage c aused by an intracerebral event. No case of heparin-induced thrombocytopeni a type II was observed. Conclusion. Thromboprophylaxis with 60 mg enoxaparin daily, in split doses, starting before surgery, is safe and appropriate in patients with hip frac tures. Clinically apparent DVT and PE are rarely observed, and bleeding com plications are comparable to those occurring with a conventional thrombopro phylactic regimen.