661 Evaluating the Efficacy of Post-Operative VTE Prophylaxis in Fragility Hip Fractures: DOAC vs LMWH

Abstract

Abstract Aim Direct oral anticoagulants (DOACs) are licensed for use as venous thromboembolism (VTE) prophylaxis in elective hip surgery however low molecular weight heparin (LMWH) is the mainstay for VTE prophylaxis in hip surgery following fragility fractures. Due to social distancing regulations during the COVID pandemic in 2021, it became increasingly difficult for community nurses to administer LMWH injections post-operatively whilst DOACs offered a less invasive alternative. This study aims to evaluate efficacy of DOACs in comparison to LMWH as VTE prophylaxis following hip surgery in fragility fractures. Method Retrospective, population-based cohort study of patients discharged on VTE prophylaxis with LMWH and DOAC in 2019 and 2021 respectively following fragility hip fracture. Data was obtained through National Hip Fracture Database and electronic medical records. Data collected included patient demographics, comorbidities, current medications, time to surgery, level of independence pre- and post-discharge and length of stay. Main outcomes assessed were incidence of VTE within 6 months. Results A total of 200 randomly selected patients were included. Following discharge, incidence of VTE was 1% in the LMWH group (n = 100) and 1% in the DOAC group (n = 100). All patients received LMWH and TED anti-embolism stockings as an inpatient. Average length of time on DOAC following discharge was 3.5 weeks. Conclusions The study shows non-inferiority of DOACs in VTE prophylaxis post-operatively when compared to LMWH. It supports a case for their use in post-operative management of fragility hip fractures. Further data surrounding compliance to DOAC following discharge will allow accurate evaluation of its efficacy.