Thromboprophylaxis for venous thromboembolism prevention in hip fracture patients

© 2017 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0) DOI 10.1080/17453674.2016.1274591 Sir,—I read with interest the study by Leer-Salvesen et al. (2016) and I would like to compliment the authors for a thorough study. It shows that preoperative start of thromboprophylaxis with low-molecular-weight heparin(LMWH) decreases 6-month mortality in femoral neck fracture patients receiving hemiarthroplasty. In a clinical setting, LMWH is a common chemoprophylaxis for venous thromboembolism (VTE) prevention. From the article, yet no VTE occurrence is stated. VTE is a major problem after hip fracture. Development of VTE is anticipated in the interval between the time of fracture and surgery since hip fracture patients cannot move the injured extremity during this period, while patients undergoing elective total joint arthroplasty are mobile. Preoperative VTE is known to occur in 3–62% of hip fracture patients (Salzman and Harris 1976, Zahn et al. 1999, Song et al. 2016).Yet no preoperative VTE is documented at the time of admission in the study. VTE is also a signifi cant risk factor for mortality. The mortality risks for patients with VTE were markedly higher during the fi rst year, especially within the fi rst 30 days after VTE diagnosis (Søgaard et al. 2014). Still, no association analysis was made between VTE and mortality in the study. Failure to bring VTE into the equation makes the association between thromboprophylaxis strategy and mortality hard to interpret in clinical practice. I would appreciate the authors’ thoughts on this.