Thromboembolism after surgical treatment of hip fractures.

Seventy-five patients ages 40 to 95 (average, 78), 60 of whom were women and 15 men, were admitted with upper femoral fractures and participated in a study designed to evaluate the possible prophylactic effects of platelet-inhibiting drugs on the incidence of thromboembolism. Aspirin, 600 mg, b.i.d., or a combination of the above doses of aspirin and hydroxychloroquine, 300 mg, b.i.d., were used from the time of admission. The study was prospective, consecutive except for a few exclusions, double-blind and randomized. Standard surgical treatment was given by three orthopedists. Venography by the 11th day was the endpoint, although daily examinations and early impedance plethysmography were also used. Twenty-five patients received placebos, 24 aspirin alone and 26 aspirin and Plaquenil. In the control group, 15 of 25 (60%) developed thrombosis and two had nonfatal pulmonary emboli. With aspirin, six of 24 (25%) had thrombosis and one a fatal embolus. In the combination group seven of 26 (27%) developed thrombosis and there were no emboli. No significant difference existed between treatment groups, but there was significant difference between the control and treatment group at the 2% level by the Yates chi2 test. Treated women received significant protection against thromboses (p less than 0.02); 13 of 20 untreated women had deep thromboses versus 12 of 40 in the treated women. Aspirin prophylaxis is significantly useful in fractured hip patients. The combination of aspirin and Plaquenil offers no additional benefit and only leads to complications from hematomas.