Venous thromboembolism prophylaxis post-discharge in hip fracture surgery patients: what to do if the patient is taking antiplatelets

Conclusions

Owing to the high risk of VTE post-HFS, it is important that appropriate prophylaxis is given and continued post-discharge. NICE advises Fondaparinux or low-molecular-weight heparin (LMWH) for a total of 28–35 days. The American College of Chest Physicians recommends LMWH for 28–35 days or a novel oral anticoagulant for those unable to cooperate with daily injections.

Analysis of our initial results demonstrated poor compliance with these guidelines, partly owing to inadequate guidance on what to prescribe to those taking single or dual antiplatelet therapy. A literature review found no relevant evidence-based guidelines. We therefore created new guidelines based on the consensus opinion of the trust VTE task force, as follows.

• Patients taking single antiplatelet therapy should  also receive rivaroxiban for 5 weeks.

•  Those taking dual antiplatelet therapy should not receive additional thromboprophylaxis owing to increased bleeding risk.

• Those on warfarin require no added prophylaxis. 

Using this, 34% of patients in the initial audit and 56% in the re-audit received adequate post-discharge VTE prophylaxis. More should be done to ensure that appropriate prophylaxis is prescribed and guidelines should be updated to include recommendations on prophylaxis in patients taking antiplatelets.