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Anticoagulant Use Pre- and Post-Hip Fracture and Other Emergency Orthopedic Surgery: A Review of Guidelines

Last updated: March 19, 2015
Project Number: RC0641-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What are the evidence-based guidelines for discontinuation or modification of anticoagulation therapy for patients requiring emergency orthopedic surgical intervention?
  2. What are the evidence-based guidelines for the use of dalteparin pre- and post-hip surgery for patients requiring emergency orthopedic surgical intervention?

Key Message

One evidence-based guideline was identified that provides recommendations for pre- and post-surgical doses and frequency of dalteparin administration for VTE prophylaxis in surgical patients; 5000 units of dalteparin subcutaneously were recommended at 12 hours before surgery, followed by 5000 units delivered once daily post-operatively. Potential modifications for high-risk situations were also offered. No evidence-based guidelines were identified regarding treatment of patients on existing anticoagulation therapy requiring emergency orthopedic surgical intervention.