Prospective study on the efficacies of fondaparinux and enoxaparin in preventing venous thromboembolism after hip fracture surgery

Venous thromboembolism (VTE) is a common complication in hip fracture surgery (HFS). Fondaparinux (FPX) and enoxaparin (ENO) have been reported to decrease the incidence of VTE after HFS. The purpose of this study was to determine the efficacies of FPX and ENO and the superior agent for preventing VTE after HFS by performing a prospective study in a Japanese population. Eighty-four Japanese patients who underwent HFS were assigned to either FPX (received FPX 1.5 or 2.5 mg/day for 14 days), ENO (received ENO 2000 IU once or twice/day for 14 days), or untreated control (CTRL) groups in order of surgery. All patients underwent ultrasonography of the lower extremities 7 days after HFS to evaluate the extent of deep-vein thrombosis. Incidence of VTE, D-dimer values measured at admission and 7 and 14 days after HFS, and the side effects of FPX and ENO were compared. The incidence of VTE and the D-dimer values on days 7 and 14 in the FPX group were significantly lower than the corresponding levels in the CTRL group (P < 0.05). The D-dimer values on day 7 in the ENO group were significantly lower than those in the CTRL group, whereas the incidence of VTE was not significantly different. Side effects were observed in 3 cases: major bleeding occurred in 2 patients who received FPX, whereas minor bleeding occurred in 1 patient who received ENO. We concluded that FPX was the superior agent for preventing VTE after HFS. However, patients receiving FPX should be monitored for bleeding.