warfarin and Femoral-Fractures

Patients with a fracture of the proximal femur are at high risk for thromboembolic complications necessitating some form of preoperative and postoperative thromboembolic prophylaxis. Despite the knowledge that patients with a proximal femur fracture are at particularly high risk for both deep venous thrombosis and pulmonary embolism, there is no consensus on which strategy is most effective at preventing thromboembolic events in this patient population. The pathophysiology and associated risk factors for thromboembolic complications in this patient population are discussed. We present a review of studies that address the efficacy and safety of both mechanical and pharmacological methods of thromboembolic prophylaxis to assist the orthopedic surgeon in selecting among the different modalities available for thromboembolic prophylaxis.

Topics: Anticoagulants; Aspirin; Bandages; Dextrans; Femoral Fractures; Fibrinolytic Agents; Fracture Fixation, Internal; Heparin; Humans; Platelet Aggregation Inhibitors; Risk Factors; Thromboembolism; Treatment Outcome; Warfarin

Topics: Aged; Dental Care for Disabled; Female; Femoral Fractures; Humans; Warfarin

A study of post-mortem examinations performed between 1970 and 1979 at a specialist orthopaedic hospital revealed that the overall mortality rate due to pulmonary embolism was 0.23% and that pulmonary embolism was responsible for 19.1% of hospital deaths. The majority of these fatalities occurred following operation for either fractured proximal femur or total hip replacement. During the decade, 928 patients were operated upon for fractured proximal femur, none received prophylactic anticoagulation therapy and the mortality rate due to pulmonary embolism was 17.7%. However, the yearly mortality rate decreased with time and this change was attributed to earlier operation and early mobilisation. Over the same period, 3016 patients underwent total hip replacement, 20% were anticoagulated prophylactically; the mortality rate due to pulmonary embolism was 0.63%. In those patients who died of pulmonary embolism, post-mortem evidence of deep vein thrombosis was usually found, but no relationship between site of thrombosis and side of operation was observed. Pulmonary embolism was diagnosed in only a few patients although on later consideration at least a third of patients had symptoms suggestive of previous emboli. Possible improvements in diagnosis are discussed and a more rational approach to prophylactic anticoagulation suggested.

Topics: Dextrans; Femoral Fractures; Hip Prosthesis; Humans; Leg; Orthopedics; Pulmonary Embolism; Thrombosis; Warfarin

Topics: Aged; Drug Evaluation; Femoral Fractures; Heparin; Hip Injuries; Humans; Thromboembolism; Thrombophlebitis; Warfarin

Topics: Aged; Animals; Blood Coagulation; Drug Therapy, Combination; Female; Femoral Fractures; Fibrinogen; Heparin; Hip; Hip Joint; Humans; Iodine Radioisotopes; Postoperative Complications; Pulmonary Artery; Pulmonary Embolism; Radiography; Radionuclide Imaging; Thromboembolism; Thrombophlebitis; Warfarin

Topics: Adolescent; Adult; Aged; Anticoagulants; Arthritis, Rheumatoid; Female; Femoral Fractures; Follow-Up Studies; Gastrointestinal Hormones; Hematoma; Hip; Hip Dislocation; Hip Joint; Humans; Iatrogenic Disease; Joint Prosthesis; Male; Middle Aged; Ossification, Heterotopic; Osteoarthritis; Postoperative Complications; Thromboembolism; Warfarin

Topics: Adult; Aged; Anticoagulants; Female; Femoral Fractures; Fractures, Bone; Hemorrhage; Humans; Male; Middle Aged; Pelvic Bones; Postoperative Complications; Spinal Injuries; Thromboembolism; Warfarin

Topics: Anticoagulants; Drug Therapy; Femoral Fractures; Femoral Neck Fractures; Fracture Fixation; Fractures, Bone; Humans; Immobilization; Pelvic Bones; Preventive Medicine; Thromboembolism; Warfarin