Formation and Development of Deep Vein Thrombosis in Hip Fracture Patients With and Without Anticoagulation
- 1Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
Abstract
Background: Continuous ultrasound was done on newly admitted hip fracture patients to evaluate post-fracture anticoagulation efficacy, perioperative lower limb deep vein thrombosis timing, and thrombosis distribution/prognosis in those on different thromboprophylaxis.
Methods: This randomized clinical trial enrolled patients with fresh hip fractures (age >18 years; injury-to-admission time ≤24 h). Eligible patients without thrombosis on admission ultrasound were randomly assigned in a 2:1 ratio to the anticoagulation group or the non-anticoagulation group. The anticoagulation group received nadroparin calcium (Fraxiparine, 3800 IU/0.4 mL subcutaneously once daily) plus mechanical thromboprophylaxis with an intermittent plantar pressure pump. The non-anticoagulation group received mechanical thromboprophylaxis alone. Bilateral lower extremity venous ultrasound was performed daily throughout hospitalization. Venous blood was collected at four time points (admission, 1 day pre-op, 1 day post-op, 3 days post-op) for routine blood tests and D-dimer measurement. Thrombosis type, occurrence time, location, and laterality were recorded. This intensive ultrasound surveillance protocol was used solely for research purposes and is not the standard.
Results: This study included 330 patients (193 females, 137 males), mean age 67.39 ± 16.69 years (18-94 years), injury-to-admission time ≤24 h, mean preoperative waiting time 3.48 ± 1.68 days, mean hospital stay 7.19 ± 2.64 days. There were 178 (53.9%) femoral neck fractures and 152 (46.1%) intertrochanteric and subtrochanteric fractures. Six patients with post-admission proximal thrombosis had pre-procedure inferior vena cava filter implantation; no pulmonary embolism occurred during hospitalization. Anticoagulant group (201 patients): 42 (20.89%) pre-op thrombosis, 81 (40.29%) post-op thrombosis. Non-anticoagulant group (129 patients): 26 (20.15%) pre-op thrombosis, 55 (42.64%) post-op thrombosis.
Conclusions: Continuous ultrasound surveillance reveals that days 2–3 post-injury and the first postoperative day represent the periods of highest thrombotic risk in patients with acute hip fractures. However, because most detected DVTs were distal and asymptomatic, and no pulmonary embolism or death occurred in either group, the clinical value of routine, protocol-driven ultrasound screening has yet to be established. Selective screening guided by symptoms or high-risk features may offer a more clinically appropriate strategy. Future studies should determine whether early DVT detection in this population translates into improved patient-important outcomes.
Related
- Anticoagulant Prophylaxis with Edoxaban for Asymptomatic Isolated Distal Deep Vein Thrombosis in Perioperative Hip Fracture Patients.
- Association Between Admission Neutrophil Count and Preoperative Deep Vein Thrombosis Risk in Older Patients with Hip Fracture: A Retrospective Cohort Study.
- Development and temporal validation of a clinical prediction score for deep vein thrombosis following femoral neck fracture surgery: a retrospective cohort study with decision curve analysis
- Development and internal validation of a nomogram for estimating concurrent superficial vein thrombosis at presentation in patients with lower extremity varicose veins
- Development and Validation of a Perioperative Risk Update Model for Postoperative Delirium in Patients Aged ≥ 80 Years Undergoing Hip Fracture Surgery: A Retrospective Cohort Study
BibTeX
@article{fei2026formation,
title = {{Formation and Development of Deep Vein Thrombosis in Hip Fracture Patients With and Without Anticoagulation}},
author = {Chen Fei and Fan Xu and Wei Fan and Chen Wang and Wu-Qiang Jiang and Zhe Song and Kun Zhang and Peng-Fei Wang},
journal = {Clinical and Applied Thrombosis/Hemostasis},
year = {2026},
month = sep,
doi = {10.1177/10760296261487841},
url = {https://doi.org/10.1177/10760296261487841},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Formation and Development of Deep Vein Thrombosis in Hip Fracture Patients With and Without Anticoagulation
AU - Chen Fei
AU - Fan Xu
AU - Wei Fan
AU - Chen Wang
AU - Wu-Qiang Jiang
AU - Zhe Song
AU - Kun Zhang
AU - Peng-Fei Wang
PY - 2026
DA - 2026/09/16
JO - Clinical and Applied Thrombosis/Hemostasis
DO - 10.1177/10760296261487841
UR - https://doi.org/10.1177/10760296261487841
AB - Background: Continuous ultrasound was done on newly admitted hip fracture patients to evaluate post-fracture anticoagulation efficacy, perioperative lower limb deep vein thrombosis timing, and thrombosis distribution/prognosis in those on different thromboprophylaxis. Methods: This randomized clinical trial enrolled patients with fresh hip fractures (age >18 years; injury-to-admission time ≤24 h). Eligible patients without thrombosis on admission ultrasound were randomly assigned in a 2:1 ratio to the anticoagulation group or the non-anticoagulation group. The anticoagulation group received nadroparin calcium (Fraxiparine, 3800 IU/0.4 mL subcutaneously once daily) plus mechanical thromboprophylaxis with an intermittent plantar pressure pump. The non-anticoagulation group received mechanical thromboprophylaxis alone. Bilateral lower extremity venous ultrasound was performed daily throughout hospitalization. Venous blood was collected at four time points (admission, 1 day pre-op, 1 day post-op, 3 days post-op) for routine blood tests and D-dimer measurement. Thrombosis type, occurrence time, location, and laterality were recorded. This intensive ultrasound surveillance protocol was used solely for research purposes and is not the standard. Results: This study included 330 patients (193 females, 137 males), mean age 67.39 ± 16.69 years (18-94 years), injury-to-admission time ≤24 h, mean preoperative waiting time 3.48 ± 1.68 days, mean hospital stay 7.19 ± 2.64 days. There were 178 (53.9%) femoral neck fractures and 152 (46.1%) intertrochanteric and subtrochanteric fractures. Six patients with post-admission proximal thrombosis had pre-procedure inferior vena cava filter implantation; no pulmonary embolism occurred during hospitalization. Anticoagulant group (201 patients): 42 (20.89%) pre-op thrombosis, 81 (40.29%) post-op thrombosis. Non-anticoagulant group (129 patients): 26 (20.15%) pre-op thrombosis, 55 (42.64%) post-op thrombosis. Conclusions: Continuous ultrasound surveillance reveals that days 2–3 post-injury and the first postoperative day represent the periods of highest thrombotic risk in patients with acute hip fractures. However, because most detected DVTs were distal and asymptomatic, and no pulmonary embolism or death occurred in either group, the clinical value of routine, protocol-driven ultrasound screening has yet to be established. Selective screening guided by symptoms or high-risk features may offer a more clinically appropriate strategy. Future studies should determine whether early DVT detection in this population translates into improved patient-important outcomes.
SN - 1076-0296
SN - 1938-2723
ER -