Abstract
Background
Venous thromboembolism (VTE) is a common complication of pelvic and acetabular fracture fixation. There is, however, currently limited data to guide clinical decisions on thromboprophylaxis choice in these patients.
Methods
This is a prospective study with retrospective analysis of all the patients who were admitted to the Northern General Hospital between August 2009 and March 2011. 2 consultants using same technique and peri-operative regime carried out all procedures. All patients were administered prophylactic enoxaparin and those who were admitted via another hospital had a pre-operative Doppler scan. Post-operatively all patients were commenced on warfarin, or low molecular weight heparin (enoxaprin) if warfarin was contra-indicated, and was continued for three months after discharge.
Results
Eighty-nine patients were admitted during this period of which 25 were treated conservatively and were excluded from the study. The mean age of patients was 39.7 years (range 17 to 83) & 73% of those were men. 65% were involved in RTA and 49% had more than one injury. 46 patients were transferred from another hospital. Of those 3 had DVT confirmed on Dopplers and had IVC filters inserted preoperatively. 52 patients were treated with warfarin and 12 with Clexane. Two patients had warfarin related complications (thigh haematoma and small subdural haematoma). Both were treated conservatively and made a full recovery. Two of the warfarin-treated (3.8%) and one of enoxaparin-treated (8%) patients developed DVT/PE. One of the two warfarin-treated patients had a PE despite having an INR of 4.2 and the other patient upon transferring to local hospital had his warfarin stopped prematurely.
Conclusions
The study shows that preoperative enoxaparin followed by postoperative warfarin is an effective thromboprophylaxis regime and is associated with low complication rate.
