Are factor Xa inhibitors effective thromboprophylaxis following hip fracture surgery?: A large national database study

Nov 6, 2017Injury

Do blood thinners that block factor Xa help prevent clots after hip fracture surgery? A large national study

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Abstract

DVT rates at thirty days were 5.03% for warfarin, 2.91% for Factor Xa inhibitors, and 3.48% for enoxaparin.

Factor Xa inhibitors may be effective for preventing deep venous thrombosis (DVT) following hip fracture surgery.
Pulmonary embolism (PE) rates were significantly lower in patients treated with enoxaparin compared to other treatments.
No significant differences were observed in rates of other complications among the treatment groups.
The effectiveness of Factor Xa inhibitors for DVT prophylaxis is comparable to that of warfarin and enoxaparin.

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INTRODUCTION: The purpose of this study was to evaluate the effectiveness of Factor Xa inhibitors (XaI) for thromboprophylaxis following hip fracture surgery in a large cohort of patients, and compare XaI against warfarin and enoxaparin.

METHODS: Patients undergoing hip fracture surgery from 2007 to 2015 were identified in a large claims database. Patients prescribed warfarin, XaI, or enoxaparin within 2 weeks of surgery were identified and grouped into cohorts. Medical comorbidities and complication incidences, including deep venous thrombosis (DVT), pulmonary embolism (PE), and bleeding complications were calculated. Chi-square analysis was performed and adjusted residuals calculated to determine significant differences.

RESULTS: DVT rates were significantly different between groups at thirty days only (5.03% warfarin, 2.91% XaI, 3.48% enoxaparin, p=0.047). PE rates were significantly different at all time points; enoxaparin had the lowest rates. There were no differences in the rates of other complications.

DISCUSSION: XaI are an option for thromboprophylaxis in hip fracture patients, although their possible decreased effectiveness against PE compared to enoxaparin should be considered.

CONCLUSIONS: This study compares the effectiveness of Factor Xa inhibitors to warfarin and enoxaparin for hip fracture patients, using a large national database. In this study, Factor Xa inhibitors had similar effectiveness for DVT prophylaxis compared to these agents.

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Are factor Xa inhibitors effective thromboprophylaxis following hip fracture surgery?: A large national database study

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