Comparative Study of the Effects of Different Anticoagulation Regimens in Deep Vein Thrombosis Prevention After Intertrochanteric Fracture in Elderly

Summary

Hip fractures are a common but deadly elderly injury, and perioperative complications like deep vein thrombosis (DVT) can cause swelling, pain, and fatal embolism, even with anticoagulant treatment. This paper compares the effect of enoxaparin and lower limb circulation (LLC) on DVT prevention.

Abstract

The paper aims to investigate the difference between the effect of enoxaparin alone and enoxaparin + lower limb circulation (LLC) in the prevention of deep vein thrombosis (DVT) after intertrochanteric fracture in older people and to provide a basis for clinical anticoagulant therapy. A total of 121 patients undergoing hip fracture (HF) surgery were divided into the enoxaparin group (71 patients) and the enoxaparin + LLC group (50 patients) to compare the baseline features, changes in D-Dimer Index (DDI), and the incidence and distribution of DVT between the two groups. There was no significant difference between the baseline data of the two groups (p > 0.05). There was no significant difference between the D-Dimer Levels (DDL) 1 day after surgery (p = 0.191). But 3 days after surgery, the D-Dimer level was significantly lower in the enoxaparin + LLC group than in the enoxaparin alone group (p < 0.05). The incidence of DVT in both groups was 35.21% and 36.00% and was not statistically different (p > 0.05). No significant difference was seen in the distribution of DVT types between the two groups (p > 0.05). However, there were two popliteal vein thromboses and one femoral vein thrombosis in the enoxaparin alone group. The enoxaparin + LLC group was better at reducing the D-Dimer level than the enoxaparin group, but there was no significant difference in the incidence and distribution type of DVT. It is recommended that the proper anticoagulation regimen be selected based on the patient's risk and that the postoperative D-Dimer monitoring be supported.

Introduction

China's aging population increases the death rate, with new cases exceeding 1 million annually. Medical experts predict an annual increase of 1.3 million elderly HF patients by 2050^1,2. In patients with HF, deep-vein thrombosis (DVT) is one of the common and serious perioperative complications³. DVT can cause swelling and pain in the lower limbs and severe thrombus rupture into the pulmonary flow, causing fatal pulmonary embolism^4,5. One study has presented that the rate of preoperative lower limb DVT in HF was 38.25% and 56....

Protocol

​This study strictly adhered to the principles of medical ethics and was approved by the hospital ethics committee of the Department of Orthopedics at Beijing Tongzhou District Integrated Traditional Chinese and Western Medicine Hospital, Beijing, China. All eligible participants are enrolled in the study according to the inclusion and exclusion criteria after obtaining informed consent.

Study subjects
This retrospective study includes 126 patients undergoing intertrochanteric fracture surgery in the hospital from January 2021 to December 2022. The inclusion of 121 patients in the study was subject to their succ....

Results

Baseline data comparison
Table 1 concludes that the differences between the two groups in the baseline features of age, gender, disease duration, fracture stability, operation duration, hospitalization days, and operation methods were insignificant (p > 0.05); the baseline features were comparable and could be used for subsequent analysis.

DDI comparison
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Discussion

This study showed no significant difference in baseline data (p > 0.05), including age, gender, disease duration, fracture stability, surgery time, and hospital days. This indicates a high comparability of the two groups, and the subsequent analysis results are reliable. In comparing the DDI, the D-dimer level was high 1 day after surgery, but no significant difference existed between groups (p = 0.191). The study showed that the increase of D-Dimer in the early postoperative period was mainly related to surgical tra.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Anticoagulant	Xarelto (Rivaroxaban)	Bayer AG	Pharmacologic prophylaxis
Elastic Stockings	JOBST Medical Legwear	Essity	Compression therapy
Intermittent Compression Device	SCD 700 Series	Cardinal Health	Mechanical prophylaxis for DVT prevention
Ultrasound Scanner	LOGIQ E10	GE Healthcare	Diagnostic imaging for thrombus detection