Prevention

Moderate-risk cases

• low-dose heparin ^a 5000 units every 12 hours (adjusted so aPTT 1.0 to 1.1) ^a

Why?

• Both heparin and low-molecular weight heparin reduces DVT in elderly patients after surgery for proximal hip fractures ^a
• Adjusted low-dose heparin prevents more DVT than fixed dose heparin ^a
• Heparin is more cost-effective than LMWH in lower risk patients ^b

Heparin and LMWH reduce DVT in elderly patients with a hip fracture

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
elderly with a hip fracture a	heparin or LMWH	placebo or nothing	DVT at discharge	24%	0.41 (0.31 to 0.55)	5 (4 to 8)

Adjusted dose heparin prevents more DVT than fixed dose

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
elective total hip replacement a	adjusted dose heparin	fixed dose heparin	DVT at 9 days	39%	67% (20% to 100%)	4 (2 to 13)