Prevention of fatal pulmonary embolism in patients with fractures of the neck of the femur.

Patients with fractures of the neck of the femur have an extremely high incidence of venous thrombosis and pulmonary emboli, if not receiving prevention with drugs. From a prospective, randomized multicenter trial comparing the effectiveness of two methods for the prevention of postoperative fatal pulmonary emboli, we analyzed those patients having been operated upon for a fracture of the neck of the femur. One hundred and seventy-two patients having had heparin-DHE prevention and 157 having had dextran prevention are compared with 150 patients in the control group and 165 patients who were given phenindione for anticoagulation orally. The data from the latter two groups stem from a study done in 1959 by Sevitt and Gallagher which for the first time established the value of oral anticoagulation for reducing pulmonary emboli. All three prophylactic methods reduce the incidence of pulmonary emboli to the same degree. The mortality associated with pulmonary emboli is 2 per cent in the phenindione group, 2.3 per cent in the heparin-DHE group and 3.8 per cent in the dextran group, in contrast with 10 per cent in the control group. Total mortality has been lowered significantly in all three groups as compared with the control group. Fatal pulmonary emboli were found only when prophylaxis had been stopped or was incomplete and were not found when prophylactic regimen was done properly. In 1980, the hospital stay was about one week shorter than in 1959.