Heparin Prophylaxis for Elderly Patients with Pelvic Fractures

Risk Assessment and Rationale

Advanced age (91 years) is an independent risk factor for thrombosis, and when combined with prolonged immobility and pelvic fracture, creates a high-risk situation for VTE, according to the American Geriatrics Society 3, 2
The risk for DVT is directly related to continued immobility and may persist for up to 2 months following injury, as stated by the American Geriatrics Society 3

The American College of Cardiology recommends that low-molecular-weight heparin (LMWH) at prophylactic doses should be administered until the patient is fully ambulatory 1, 2
Begin pharmacological prophylaxis within 24 hours after ensuring bleeding has been controlled, as recommended by the Critical Care society 4
Continue prophylaxis for the duration of hospitalization and rehabilitation until the patient is fully ambulatory, according to the Mayo Clinic Proceedings 1
For high-risk patients, consider extending prophylaxis for up to 35 days, as suggested by the American Geriatrics Society and the Mayo Clinic Proceedings 1, 3

Combine pharmacological prophylaxis with intermittent pneumatic compression (IPC) devices and/or graduated compression stockings, as recommended by the Critical Care and World Journal of Emergency Surgery societies 4, 5
Apply mechanical prophylaxis as soon as possible, according to the Critical Care society 4

Monitor platelet counts regularly, as heparin-induced thrombocytopenia risk increases with the severity of trauma, as stated by the Critical Care society 4
Be vigilant for signs of bleeding complications, which may be more common in elderly patients, according to the Mayo Clinic Proceedings 1

Active bleeding is a contraindication for heparin prophylaxis, as stated by the Critical Care society 4
Severe thrombocytopenia (platelet count <50 × 10^9/L) is a contraindication for heparin prophylaxis, according to the Critical Care society 4
Uncontrolled hypertension is a contraindication for heparin prophylaxis, as stated by the Critical Care society 4
Known hypersensitivity to heparin is a contraindication for heparin prophylaxis, according to the Critical Care society 4