Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

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

Andrew Porter, Shuli Levy and Michael Fertleman
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.15-3-s18
Clin Med June 2015
Andrew Porter
Imperial College Healthcare Trust, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Shuli Levy
Imperial College Healthcare Trust, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Fertleman
Imperial College Healthcare Trust, London, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

Aims

To assess whether adequate post-discharge venous thromboembolism (VTE) prophylaxis is prescribed to patients who underwent hip fracture surgery (HFS) and to consider what should be prescribed to patients who are already taking antiplatelet agents.

Methods

A retrospective study analysed discharge prescriptions of HFS patients at a London teaching hospital over a 10-week period. Both anticoagulant and antiplatelet prescriptions were recorded. A re-audit was then carried out again over a 10-week period.

Results

In the initial audit, 40 patients had HFS and had been discharged with a completed discharge prescription. The repeat audit included 41 patients. The results are shown in the table below.

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.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 1.

VTE prophylaxis post-discharge.

Conflict of interest statement

There was no conflict of interest in this audit.

  • © Royal College of Physicians 2015. All rights reserved.
Back to top
Previous article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Venous thromboembolism prophylaxis post-discharge in hip fracture surgery patients: what to do if the patient is taking antiplatelets
Andrew Porter, Shuli Levy, Michael Fertleman
Clinical Medicine Jun 2015, 15 (Suppl 3) s18; DOI: 10.7861/clinmedicine.15-3-s18

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Venous thromboembolism prophylaxis post-discharge in hip fracture surgery patients: what to do if the patient is taking antiplatelets
Andrew Porter, Shuli Levy, Michael Fertleman
Clinical Medicine Jun 2015, 15 (Suppl 3) s18; DOI: 10.7861/clinmedicine.15-3-s18
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Aims
    • Methods
    • Results
    • Conclusions
    • Conflict of interest statement
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Thrombotic thrombocytopenic purpura specialist centres: providing better outcomes for patients with rare but life-threatening conditions
  • Can a perioperative physician improve care and reduce length of stay in a surgical emergency admission unit?
  • Measurement and recording errors of the respiratory rate
Show more CLINICAL RESEARCH AND CASE REPORTS

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians