OTA 2012 Posters

Scientific Poster #7 Hip/Femur OTA-2012

New Oral Antithrombotic for Hip Fracture: A Standardized Protocol

Daniel Godoy, MD1; Alberto Cid Casteulani2; Kenneth Iserson, MD3; Santiago Svarzchtein, MD2; Eliseo Firman, MD2; Sebastian Sasaki, MD2; Diego Roncolato, MD2;
1Hospital Italiano de Buenos Aires, Buenos Aires Argentina;
2Centro Medico Integral Fitz Roy, Buenos Aires, Argentina;
3University of Arizona, Tucson, Arizona, USA

Background/Purpose: Patients with hip fracture have a reported incidence of deep vein thrombosis (DVT) between 25% and 63 %. A new oral antithrombotic (oral, single dose, no laboratory test) offers a way to reduce this incidence. A new drug has been approved for this use in Argentina. In 2009, we started a protocol for DVT prophylaxis: (A) administration of rivaroxaban (Xarelto, Bayer) 10 mg orally once a day within 24 hours of injury; (B) Doppler scan examination on both limbs immediately after surgery and 30 days after surgery; (C) ventilation perfusion scintigraphy (V/Q scan) if the patient showed clinical signs of pulmonary embolism (PE); (D) clinical evaluation at 45, 90, and 120 days.

Methods: From June 2009 to June 2011, we treated 145 consecutive patients with 147 proximal femur fractures (2 bilateral). Associated injuries were found in 27 patients. ISS in this group ranged from 1 to 75 (mean, 9). There were 47 total hip replacements (23 uncemented, 21 hybrid, and 3 cemented); 51 endomedullary systems, and 49 dynamic hip screws. 135 had epidural anesthesia and 10 required general anesthesia. Time to surgery ranged from 1 to 6 days (average, 1.8 days). The patient ages were 18 to 73 years (average, 57.3 years), with 86 male (59.3%), and 59 female (40.7%).

Results: No patient had a detected DVT after postoperative Doppler scan. During the 30-day follow-up, 1 had a PE (V/Q scan positive, Doppler scan negative) and 11 had DVTs (3 proximal and 8 distal). The 3 symptomatic patients included 2 with distal DVT who developed symptoms during in-hospital rehabilitation and 1 with a proximal DVT who was readmitted. Both started low molecular-weight heparin treatment per our hospital guidelines. The incidence of PE in the series was 0.68%, Doppler scan–detected DVT 7.5% (2% symptomatic DVT). No patient died during the study follow-up. There was no increase in bleeding, wound oozing, or extra transfusions. Complications included 1 hematoma involving two-thirds of the thigh, 1 wound infection requiring surgical toilet, and 2 patients with rash that resolved after discontinuation of the antithrombotic drug. During clinical evaluation at 45, 90, and 120 days, no clinical complications related to the use of this protocol were detected.

Conclusion: Rivaroxaban is a safe and effective method of thromboprophylaxis in patients with hip fractures with or without associated injuries.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.