PB1497 - Patients Prefer Oral Agents Over Subcutaneous Injections for Thromboprophylaxis Following Hip Fracture Surgery

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Prism Schneider, MD, PhD, FRCSC (she/her/hers)

Clinician-Scientist, Orthopaedic Surgery
University of Calgary
Calgary, Alberta, Canada

Co-Author(s)

SY

Stephanie Yee

Research Data Administrator
University of Calgary
Calgary, Alberta, Canada
CT

Casandra Tan

Clinical Research Nurse
University of Calgary
Calgary, Alberta, Canada
DY

Daniel You

Orthopaedic Resident
University of Calgary
Calgary, Alberta, Canada
PD

Paul Duffy

Orthopaedic Trauma Surgeon
University of Calgary
Calgary, Alberta, Canada
AD

Andrew Dodd

Orthopaedic Trauma Surgeon
University of Calgary
Calgary, Alberta, Canada
RM

Ryan Martin

Orthopaedic Trauma Surgeon
University of Calgary
Calgary, Alberta, Canada
KR

Kim Rondeau

Biostatistician
University of Calgary
Calgary, Alberta, Canada
RK

Robert Korley

Orthopaedic Trauma Surgeon
University of Calgary
Calgary, Alberta, Canada

Background: Despite thromboprophylaxis, rates of symptomatic deep vein thrombosis (DVT) are as high as 15.6%, and pulmonary embolism (PE) as high as 8.4% following hip fracture surgery (HFS). LMWH has been used most frequently for thromboprophylaxis; however, adherence is reported as low as 16.3% after HFS, thereby limiting its effectiveness.

Aims: To quantify patient preference for thromboprophylaxis following HFS, in order to improve adherence and reduce the morbidity and mortality associated with venous thromboembolism (VTE).

Methods: This is a prospective cohort of patients 50 years of age or older requiring HFS, who received LMWH for 28 days post-operatively (REB16-2240). Following informed consent, each participant provided their preferred method of thromboprophylaxis at each follow-up until three months post-operatively. Patients were excluded if they were receiving pre-injury therapeutic anticoagulation. Descriptive statistics were used, as well as t-tests and chi-square analysis to compare preference based on age and sex (alpha=0.05).

Results: From 101 consecutive patients, 78 patients (75.5 (+/- 11.2) years; 73.1% female) completed the survey at 2-week post-operatively. The majority of patients (73%; n=57) preferred oral thromboprophylaxis over a subcutaneous injection. Within this group, 38% (n=30) provided a preference response at a subsequent follow-up, and 20% (n=6) changed their preference, with the majority (66%; n=20) changing their response from a preference for subcutaneous injection to a preference for oral thromboprophylaxis. At the 2-week follow-up, there was no significant difference between sex (p=1.0) or age for preference of oral thromboprophylaxis [oral preference mean age = 76.1 (+/- 11.0) years compared to injectable preference 73.8 (+/- 11.8) years; p=0.45].

Conclusion(s): Patients with hip fracture prefer oral thromboprophylaxis over subcutaneous injections for VTE prevention following surgery. Should oral thromboprophylaxis be safe and effective in VTE prevention, the use of an oral medication may improve patient adherence, particularly amongst elderly patients, where lack of independence and cognitive impairment are common.