A Singapore study has observed a high prevalence of symptomatic venous thromboembolism (VTE) in patients who underwent distal femur fracture (DFF) surgery. Those with advanced age or who are overweight are more likely to develop symptomatic VTE.
“Advanced age (≥60 years) and being overweight (BMI ≥25 kg/m2) are two independent risk factors for sVTE in DFFs,” the researchers said. “The use of routine pharmacological thromboprophylaxis should be considered as a preventative measure.”
A total of 131 patients who underwent DFF surgery without routine pharmacological thromboprophylaxis between October 2007 and November 2026 were included in the analysis.
The researchers compared patients with symptomatic VTE with those without and explored differences in demographics and fracture-related characteristics. To eliminate confounders, they used multivariable logistic regression. Cases of symptomatic VTE included symptomatic pulmonary embolism (PE) and symptomatic deep vein thrombosis (DVT). [Singapore Med J 2026;67:368-373]
Twenty (15.3 percent) of the 131 patients had symptomatic VTE. Of these, 16 (12.2 percent) had DVT and six (4.6 percent) had PE, with two patients having both DVT and PE.
“The prevalence of symptomatic VTE in our series was higher … when compared to traumatic hip fracture patients who underwent hemiarthroplasty (DVT 4.1 percent) and elective total hip arthroplasty patients (DVT 8 percent), both treated without routine pharmacological thromboprophylaxis,” the researchers said. [Singapore Med J 2016;57:69-72; J Orthop Surg 2011;19:50-53]
Underreported
A recent meta-analysis of 38 studies involving 11,769 Asian patients with total knee and total hip arthroplasties reported a 14.2-percent total incidence of DVT and 0.73-percent total incidence of PE. [Thromb Res 2021;198:86-92]
“[W]e echo the report by Ricci [and colleagues] that the VTE rates for DFFs are underreported and warrant further investigations to review if routine pharmacological thromboprophylaxis is necessary for this cohort of patients to reduce the mortality and morbidity associated with DFF,” the researchers said. [OTA Int 2019;2:e027]
In the current study, most patients with symptomatic VTE (n=17, 85.0 percent) were aged ≥60 years compared with nearly half (n=62, 55.9 percent) of those without (p=0.014). Likewise, the majority of patients with symptomatic VTE (n=14, 82.4 percent) had BMI ≥25 kg/m2 compared with about half (n=49, 53.3 percent) of those without (p=0.032).
In multivariate analysis, age ≥60 years (adjusted odds ratio [OR], 5.05; p=0.040) and BMI ≥25 kg/m2 (adjusted OR, 3.92; p=0.045) demonstrated an independent association with an increased risk of symptomatic VTE after DFF surgery.
Earlier studies suggested that age was associated with increased levels of coagulation proteins without a proportional increase in anticoagulant factors and being overweight could elevate the risk of venous stasis, a catalyst for the development of VTE. [J Thromb Haemost 2010;8:2105-2112; Semin Thromb Hemost 2002;28:555-568; Arch Intern Med 2008;168:1678-1683]
“As a result, we opine that healthcare providers should pay particular attention to the increased risk of symptomatic VTE in [older] DFF patients and those with BMI ≥25 kg/m2,” the researchers said.
“More studies with a larger number of patients are required for further investigations, and the use of routine pharmacological thromboprophylaxis should be considered as a preventative measure,” they added.