Risk of Alcohol Use in Thrombosis Following Emergency Hip Replacement for Femoral Neck Fracture

Thrombosis Risk in Hip Fracture Patients

Venogram and ventilation/perfusion studies have shown a prevalence of 37% for deep vein thrombosis (DVT) and 6% for pulmonary embolism (PE) in hip fracture patients 2
Clinical symptoms are only seen in 1-3% of DVTs and 0.5-3% of PEs, making screening important 2

Alcohol dependence is common, under-diagnosed, and a risk factor for falls leading to femoral neck fractures 1
Patients with alcohol dependence are at risk for significant peri-operative morbidity, including thrombotic complications 1
Initial Bispectral Index (BIS) levels may be abnormally low in alcoholic patients, which can affect anesthetic management and potentially increase thrombosis risk 2

Fondaparinux or low molecular weight heparins should be prescribed for thromboprophylaxis 2
Low molecular weight heparin should be administered between 18:00 and 20:00 to minimize bleeding risk related to neuraxial anesthesia during daytime trauma lists 2
Thromboembolism stockings or intermittent compression devices should be employed intra-operatively 2
Ensure the patient remains warm and well-hydrated throughout perioperative care 2
Expedited surgery and early mobilization are recommended to reduce DVT risk 2
Regional anesthesia techniques may help reduce DVT risk compared to general anesthesia 2

Patients with alcohol dependence may require additional monitoring during surgery, including BIS monitoring to optimize anesthesia depth 3
These patients may have altered coagulation profiles and require careful assessment of thrombosis risk 1
Alcohol withdrawal should be anticipated and managed appropriately to prevent complications that could increase thrombosis risk 1
Optimized perioperative fluid management is particularly important in these patients to reduce morbidity 2

Careful balance is needed between thromboprophylaxis and bleeding risk, especially when considering neuraxial anesthesia techniques 2