Proximal deep vein thrombosis after hip fracture surgery in elderly patients despite thromboprophylaxis

Objective: Hip fracture is very common in the elderly population and is a highly significant risk factor for the development of deep vein thrombosis. Thus, deep vein thrombosis prophylaxis is indicated in these patients. The objective of this study was to determine the prevalence of proximal deep vein thrombosis in patients receiving usual prophylaxis, to characterize patients with deep vein thrombosis, and to assess the effect of deep vein thrombosis on the course and outcome of rehabilitation. Design: An interventional prospective study in a rehabilitation geriatric ward in a tertiary university hospital in southern Israel involving 644 elderly patients undergoing rehabilitation after surgery for hip fracture. Thromboprophylaxis included graduated compression stockings and subcutaneous low-molecular-weight heparin. All patients underwent Doppler ultrasonography to identify proximal deep vein thrombosis. Conventional scales were used to measure functional and cognitive status. Results: Thirty-nine patients developed proximal deep vein thrombosis despite thromboprophylaxis. The patients with deep vein thrombosis, compared with those without, had more episodes of stroke in the past, lower FIM™ transfer subscores at the beginning of rehabilitation, a longer rehabilitation period, and a higher mortality rate during hospitalization. Conclusions: Despite thromboprophylaxis, patients undergoing surgery for hip fracture are at significant risk to develop proximal deep vein thrombosis, which prolongs the rehabilitation time and increases mortality rates. Thus, screening Doppler sonography should be performed on all these patients to identify deep vein thrombosis. Further studies are needed to determine the optimal timing for this procedure.