Chemoprophylaxis for the Hip Fracture Patient: A Comparison of Warfarin and Low-Molecular-Weight Heparin.

Objective: To compare the rates of deep venous thrombosis (DVT), rates of pulmonary embolus (PE), and complication profiles of warfarin and low-molecular-weight heparin (LMWH) in patients undergoing operative fixation of hip fractures.

Design: Retrospective cohort study.

Setting: Insurance-based database of more than 22 million patient records.

Patients: Adult hip fracture patients who were treated operatively and received chemoprophylaxis from 2007 to 2016. A total of 7594 patients met inclusion criteria and were available for final analysis.

Intervention: Pharmacological anticoagulation with warfarin or LMWH to prevent postoperative venous thromboembolism after hip fracture surgery.

Main Outcome Measures: Development of DVT or PE within 30 and 90 days of surgery.

Results: Patients prescribed warfarin had higher rates of DVT and PE compared with those prescribed LMWH. Patients on warfarin were more likely to develop a postoperative hematoma and to be readmitted within 30 and 90 days compared with those on LMWH. Patients in both groups had similar rates of total complications.

Conclusions: Patients prescribed warfarin after hip fractures had higher rates of DVT and PE compared with those prescribed LMWH, although both agents had similar complication profiles.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.