Rostagno Carlo, Gatti Massimo, Cartei Alessandro, Civinini Roberto
Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, 50134 Firenze, Italy.
Cardiologia Generale AOU Careggi, 50134 Firenze, Italy.
J Clin Med. 2025 Jan 23;14(3):726. doi: 10.3390/jcm14030726.
Venous thromboembolism frequently complicates orthopedic surgery. The aim of the study was to evaluate the overall incidence, site, and risk factors for venous thromboembolism in patients undergoing hip fracture surgery in DVT prophylaxis according to guidelines recommendations. Standard ultrasonography (CUS) was performed in the 5-6th postoperative day in all patients who underwent hip fracture surgery between 1 January and 31 December 2019. Pharmacological prophylaxis was started within 12 h from admission. In the first half of the year, dalteparin (5000 IU/day) was available while nadroparin (38 IU/kg until 3rd postoperative day and thereafter 57 IU/kg) was available in the second part of the year. A total of 505 patients, 144 males and 361 females, with a mean age of 84 years, entered in the study. Post-operative DVT was found at screening ultrasonography in 121 patients (24%). Most involved distal veins (91) while proximal DVT occurred in 30. Two patients had not fatal pulmonary embolism (0.3%). Time to surgery ( = 0.0009) and ≥2 comorbidities ( = 0.0198) were independent predictive factors of DVT. Moreover, dalteparin prophylaxis was associated with a 1.7-times higher risk of developing a DVT compared to nadroparin. DVT occurs in 24% of patients after hip fracture surgery despite thromboprophylaxis. Time to surgery and ≥2 comorbidities were independent risk factors. The protective effects of nadroparin should be confirmed by a randomized trial. All patients with DVT were discharged with indication to anticoagulation for at least three months.
静脉血栓栓塞症常使骨科手术复杂化。本研究旨在根据指南建议，评估接受髋部骨折手术患者中静脉血栓栓塞症的总体发病率、部位及危险因素。对2019年1月1日至12月31日期间接受髋部骨折手术的所有患者，在术后第5至6天进行标准超声检查（CUS）。入院后12小时内开始药物预防。上半年使用达肝素（5000 IU/天），下半年使用那屈肝素（术后第3天前38 IU/kg，此后57 IU/kg）。共有505例患者纳入研究，其中男性144例，女性361例，平均年龄84岁。筛查超声检查发现121例患者（24%）术后发生深静脉血栓形成（DVT）。大多数累及远端静脉（91例），近端DVT发生30例。2例患者发生非致命性肺栓塞（0.3%）。手术时间（P = 0.0009）和≥2种合并症（P = 0.0198）是DVT的独立预测因素。此外，与那屈肝素相比，达肝素预防导致发生DVT的风险高1.7倍。尽管进行了血栓预防，髋部骨折手术后仍有24%的患者发生DVT。手术时间和≥2种合并症是独立危险因素。那屈肝素的保护作用应通过随机试验予以证实。所有DVT患者出院时均被指示进行至少三个月的抗凝治疗。
