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Question 5#

You are asked to see a 78-year-old woman prior to surgical repair of a femoral neck fracture. Her medical problems include hypertension, osteoporosis, and hypothyroidism. Morphine is the only medication ordered so far. She is comfortable at rest. Her BP is 136/82, HR 88, and RR 16. Her cardiac examination is normal and her lungs are clear. What is the best recommendation to prevent postoperative venous thrombosis?

A) Postoperative low-dose ASA
B) Postoperative SCDs (sequential compression devices)
C) Early mobilization and ambulation
D) Postoperative subcutaneous low-molecular-weight heparin
E) Postoperative intravenous unfractionated heparin

Correct Answer is D


After orthopedic injury, patients are at high risk of development of deep vein thrombosis. Other risk factors for DVT formation include advanced age, immobility, malignancy, hypercoagulable states, and prior history of DVT. Appropriate options for DVT prophylaxis after hip fracture include subcutaneous unfractionated heparin, low-molecular-weight heparin, or fondaparinux. SCDs (answer b) may be used in addition to chemoprophylaxis, but SCDs by themselves are not effective in hip fracture patients. Early ambulation is recommended as tolerated for all patients at risk for DVT, but is not enough to fully attenuate risk after a hip fracture. Aspirin (answer a) is never recommended by itself for inpatient DVT prophylaxis. Intravenous heparin is used for DVT therapy, not prophylaxis.