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Mechanical prophylaxis after hip fracture: what is the risk of deep vein thrombosis? A retrospective observational study
  1. Majd B Protty,
  2. Shridhar Aithal,
  3. Ben Hickey,
  4. Rebecca Pettit,
  5. Antony Johansen
  1. Trauma Unit, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Majd B Protty; majd{at}protty.net

Abstract

Graduated compression stockings carry a potential risk of pressure, vascular and other complications. Current understanding of deep vein thrombosis (DVT) risk leaves it uncertain whether patients with hip fracture should wear stockings on both legs.

Objectives To determine the association between the side of the hip fracture and the subsequent occurrence of symptomatic lower limb DVT.

Setting Single tertiary trauma centre, Wales.

Participants All 3657 patients presenting with hip fracture between 2007 and 2013 were identified from our unit's National Hip Fracture Database. We excluded 404 patients (11.0%) resident outside our catchment area, leaving a total of 3253. Median age was 83 years (±12.4).

Primary/secondary outcome measures We cross-linked patient details with Medical Physics records, to identify 634 (19.5%) who had undergone one or more lower-limb Doppler-ultrasound scans at some point during the study period. The distribution rates of DVT were calculated from this resulting data set.

Results Many of the total 634 scans were unrelated to the hip fracture, including 225 (35.5%) performed prior to the fracture. We calculated a baseline rate of DVT of 3.7/1000 patients per year, for the 3-month period immediately before the hip fracture. Scans performed following hip fracture showed DVT risk to be highest in the 3-month period after fracture (35.7/1000 patients per year). This resulted from a six-fold increase in DVTs on the side of the fracture (29.5/1000 patients per year, p<0.01). We found only a very small non-significant increase in DVT on the contralateral leg (6.1/1000 patients per year)

Conclusions The additional risk of DVT after hip fracture is essentially confined to the fractured limb—the leg to which it is most painful to apply stockings. There appears little justification for the cost and potential risk of using stockings on the contralateral leg.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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