Skip to main content
ISTH 2024 Main banner
Back
CME Evaluation

Oral Communication Session

Venous Thromboembolism

Session: VTE prophylaxis in surgical patients

OC 66.1 - Venous Thromboembolism Prophylaxis After Surgery For Hip Fracture: A Survey of Physician Practices from the HIPSTER study group.

Tuesday, June 25, 2024
14:45 – 15:00 ICT
Room: 111 A-C
Background: Guidelines on venous thromboembolism (VTE) prevention after hip fracture surgery suggest using low-molecular-weight heparin (LMWH) but based on very-low-certainty evidence. There is emerging evidence that direct oral anticoagulants (DOACs) or acetylsalicylic acid (ASA) might be safe and effective alternatives. We received funding from the Canadian Venous Thromboembolism Research Network to conduct a pilot randomized controlled trial (RCT) that will address this question.

Aims: To survey physician practice regarding VTE prophylaxis for people undergoing hip fracture surgery and preferences regarding interventions they would consider acceptable for an RCT.

Methods: We recruited a convenience sample of physicians potentially involved in the prescription of VTE prophylaxis after hip fracture surgery. We distributed the survey (August-December 2023) by email through professional organizations and social media. Participants providing informed consent answered 14 questions on demographics, their current practices for VTE prevention after hip fracture surgery, the need for an RCT on this topic, and acceptable interventions.

Results: 204 physicians from 28 countries completed the survey, with 175 (86%) being responsible for prescribing postoperative VTE prophylaxis. 172 (84%) indicated that an RCT is needed. Table 1 shows the participant characteristics, and Table 2 the current practices and preferences for an RCT. 120 (59%) physicians reported using LMWH, and ≥25% rivaroxaban/apixaban alone or after a short course of LMWH. Regarding preferences for RCT interventions, LMWH and LMWH followed by rivaroxaban/apixaban were ranked highest. 140 (69%) participants would not be comfortable if the RCT interventions included ASA alone, and >40% were uncomfortable with ASA following a short course of anticoagulant. Among orthopedic surgeons, the percentage uncomfortable with ASA alone was 39%.

Conclusion(s): LMWH was the standard of care for most of our respondents. If they were to participate in an RCT, they would prefer a trial comparing LMWH with LMWH followed by rivaroxaban/apixaban.