Duration of Prophylaxis Against Venous Thromboembolism With Fondaparinux After Hip Fracture SurgeryA Multicenter, Randomized, Placebo-Controlled, Double-blind Study

Abstract

PATIENTS UNDERGOING surgery for hip fracture are in the highest category of risk for postoperative venous thromboembolism (VTE).^1,2 Without prophylaxis, fatal pulmonary embolism is much more common after hip fracture surgery (3.6%-12.9%) than after elective hip replacement (0.1%-0.4%).¹ It has recently been reported that treatment with the new selective factor Xa inhibitor fondaparinux,^3,4 administered subcutaneously at the dose of 2.5 mg once daily for up to 11 days in patients undergoing surgery for hip fracture, reduced by 56.4% (from 19.1% to 8.3%) the rate of VTE (P<.001), with a similar safety profile to the low-molecular-weight heparin enoxaparin (the PENTasaccharide in HIp-FRActure [PENTHIFRA] Study).⁵ However, as shown in elective hip replacement surgery,^6-8 the risk of VTE may persist longer than 11 days after surgery for hip fracture.⁹ For instance, in the PENTHIFRA study, 22 of the 30 symptomatic venous thromboembolic events and 11 of the 15 fatal pulmonary embolism episodes occurred during follow-up between day 11 and day 49.⁵ The benefit of thromboprophylaxis for up to 4 weeks after surgery has now been well established in elective hip replacement surgery^6-8 and more recently in abdominal surgery for cancer,¹⁰ but no such data exist in surgery for hip fracture.