Evaluation of the anticoagulant effects of low molecular weight heparin calcium and fondaparinux sodium after intertrochanteric fractures surgery by combining thromboelastography_West China Medical Journal

Authors：

GONG Dezhi , XU Shengxi , LIU Dahai , TENG Lin ,  GOU Yongsheng

Department of Orthopedics, the first People’s Hospital of Shuangliu District / West China (Airport) Hospital Sichuan University, Chengdu, Sichuan 610200, P. R. China;

Corresponding author：

GOU Yongsheng, Email: 19934439464@163.com

Keywords：

Thromboelastography; intertrochanteric fracture; low molecular weight heparin calcium; fondaparinux sodium; deep vein thrombosis

DOI：

10.7507/1002-0179.202501192

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Objective To evaluate the anticoagulant effects of low molecular weight heparin calcium versus fondaparinux sodium (FPX) after intertrochanteric fracture surgery using thromboelastography (TEG). Methods The patient who was hospitalized at the First People’s Hospital of Shuangliu District, requiring surgical intervention for intertrochanteric fracture was selected between September 2020 and September 2022. By using a random number table grouping method, the included patients were divided into the FPX group and the low molecular weight heparin calcium group. All patients underwent TEG was performed after admission, and on postoperative days 1, 3, and 7, and color doppler ultrasound of the lower limb vessels was conducted after admission and on postoperative day 7. The occurrence of deep vein thrombosis and TEG indicators were compared between the two groups. Results A total of 80 patients were included, with 40 patients in each group. There was no statistically significant difference in age, gender, and body mass index between the two groups (P>0.05). There was no statistically significant difference in the incidence of deep vein thrombosis between the FPX group and the low molecular weight heparin calcium group before surgery (9 vs. 7 cases) and after surgery (4 vs. 8 cases) (P>0.05). At different time points, the K values of the FPX group were consistently higher than those of the low molecular weight heparin calcium group (P<0.05), while the MA and CI values were consistently lower than those of the low molecular weight heparin calcium group (P<0.05). There was no statistically significant difference in the other TEG parameters between the two groups at different time points(P>0.05). Conclusion The TEG findings suggest that the anticoagulant effect of FPX is more effective than that of low molecular weight heparin calcium following surgical treatment of intertrochanteric fractures.

Citation： GONG Dezhi, XU Shengxi, LIU Dahai, TENG Lin, GOU Yongsheng. Evaluation of the anticoagulant effects of low molecular weight heparin calcium and fondaparinux sodium after intertrochanteric fractures surgery by combining thromboelastography. West China Medical Journal, 2026, 41(1): 54-58. doi: 10.7507/1002-0179.202501192 Copy

1.	Lyew MA, Isaacson IJ. Template for rapid analysis of the thromboelastogram. Anesth Analg, 1992, 74(5): 782-783.
2.	Yang Y, Yao Z, Dai W, et al. Changes of thromboelastography in patients undergoing elective primary total knee and total hip replacement with low molecular heparin prophylaxis. J Orthop Surg Res, 2014, 9: 52.
3.	Xu X, Jiang J, Liu W, et al. Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. J Orthop Surg Res, 2019, 14(1): 430.
4.	Gurunathan U, Stanton LM, Weir RM, et al. A preliminary study using rotational thromboelastometry to investigate perioperative coagulation changes and to identify hypercoagulability in obese patients undergoing total hip or knee replacement. Anaesth Intensive Care, 2019, 47(5): 461-468.
5.	吕波, 薛锋, 唐果, 等. 下肢骨折后深静脉血栓形成的影响因素分析. 国际骨科学杂志, 2018, 39(6): 373-377.
6.	Lim TK, Koh KH, Lee SH, et al. Inferior anchor cortical perforation with arthroscopic bankart repair: a cadaveric study. Arthroscopy, 2013, 29(1): 31-36.
7.	Fei C, Wang PF, Qu SW, et al. Deep vein thrombosis in patients with intertrochanteric fracture: a retrospective study. Indian J Orthop, 2020, 54(Suppl 1): 101-108.
8.	Niu S, Li J, Zhao Y, et al. Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors. BMC Musculoskelet Disord, 2021, 22(1): 264.
9.	中华医学会临床药学分会《磺达肝癸钠药学实践专家共识》编写工作组. 磺达肝癸钠药学实践专家共识. 医药导报, 2022, 41(11): 1571-1581.
10.	Sun G, Wu J, Wang Q, et al. Factor Ⅹa inhibitors and direct thrombin inhibitors versus low-molecular-weight heparin for thromboprophylaxis after total hip or total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty, 2019, 34(4): 789-800. e6.
11.	Bala A, Huddleston JI 3rd, Goodman SB, et al. Venous thromboembolism prophylaxis after TKA: aspirin, warfarin, enoxaparin, or factor Ⅹa inhibitors?. Clin Orthop Relat Res, 2017, 475(9): 2205-2213.
12.	Yang T, Liu Z, Zhang B, et al. Comparison of the efficacy of low-molecular-weight heparin and fondaparinux sodium after total knee arthroplasty: a retrospective cohort study. BMC Musculoskelet Disord, 2023, 24(1): 552.
13.	徐厚围. 磺达肝癸钠与低分子肝素在老年髋部骨折中预防深静脉血栓的疗效比较. 南充: 川北医学院, 2023.
14.	Kwong LM. Hip fracture and venous thromboembolism in the elderly. J Surg Orthop Adv, 2004, 13(3): 139-148.
15.	Eriksson BI. Improvements in the prevention of postoperative venous thromboembolism in hip fracture patients. Orthopedics, 2003, 26(8 Suppl): s851-s858.
16.	Eriksson BI, Bauer KA, Lassen MR, et al. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. N Engl J Med, 2001, 345(18): 1298-1304.
17.	Sasaki S, Miyakoshi N, Matsuura H, et al. Prospective study on the efficacies of fondaparinux and enoxaparin in preventing venous thromboembolism after hip fracture surgery. J Orthop Sci, 2011, 16(1): 64-70.
18.	江玉, 曹燕, 王飞燕, 等. 血栓弹力图与常规凝血指标对老年创伤性骨折患者术后下肢深静脉血栓形成的预测价值分析. 中国医学前沿杂志(电子版), 2021, 13(10): 112-116.
19.	俞豪, 费杨厚雪, 闵竞, 等. RAPT 评分联合血栓弹力图 K 值及α角对创伤性骨折患者术后发生下肢深静脉血栓的诊断价值. 检验医学与临床, 2024, 21(8): 1107-1110,1117.
20.	Brill JB, Badiee J, Zander AL, et al. The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography. J Trauma Acute Care Surg, 2017, 83(3): 413-419.
21.	Gary JL, Schneider PS, Galpin M, et al. Can thrombelastography predict venous thromboembolic events in patients with severe extremity trauma?. J Orthop Trauma, 2016, 30(6): 294-298.
22.	Brown W, Lunati M, Maceroli M, et al. Ability of thromboelastography to detect hypercoagulability: a systematic review and meta-analysis. J Orthop Trauma, 2020, 34(6): 278-286.
23.	陈潇, 李玲利, 何凌霄, 等. 血栓弹力图参数联合 D-二聚体、纤维蛋白原对老年髋部骨折患者深静脉血栓形成的预测研究. 四川医学, 2022, 43(11): 1091-1096.
24.	Kumar A, Talwar A, Farley JF, et al. Fondaparinux sodium compared with low-molecular-weight heparins for perioperative surgical thromboprophylaxis: a systematic review and meta-analysis. J Am Heart Assoc, 2019, 8(10): e012184.
25.	Cuker A, Arepally GM, Chong BH, et al. American society of hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv, 2018, 2(22): 3360-3392.
26.	Gu ZC, Wei AH, Zhang C, et al. Risk of major gastrointestinal bleeding with new vs conventional oral anticoagulants: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2020, 18(4): 792-799. e61.
27.	Lundkvist J, Bergqvist D, Jönsson B. Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery. Eur J Health Econ, 2007, 8(4): 313-323.

1. Lyew MA, Isaacson IJ. Template for rapid analysis of the thromboelastogram. Anesth Analg, 1992, 74(5): 782-783.
2. Yang Y, Yao Z, Dai W, et al. Changes of thromboelastography in patients undergoing elective primary total knee and total hip replacement with low molecular heparin prophylaxis. J Orthop Surg Res, 2014, 9: 52.
3. Xu X, Jiang J, Liu W, et al. Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. J Orthop Surg Res, 2019, 14(1): 430.
4. Gurunathan U, Stanton LM, Weir RM, et al. A preliminary study using rotational thromboelastometry to investigate perioperative coagulation changes and to identify hypercoagulability in obese patients undergoing total hip or knee replacement. Anaesth Intensive Care, 2019, 47(5): 461-468.
5. 吕波, 薛锋, 唐果, 等. 下肢骨折后深静脉血栓形成的影响因素分析. 国际骨科学杂志, 2018, 39(6): 373-377.
6. Lim TK, Koh KH, Lee SH, et al. Inferior anchor cortical perforation with arthroscopic bankart repair: a cadaveric study. Arthroscopy, 2013, 29(1): 31-36.
7. Fei C, Wang PF, Qu SW, et al. Deep vein thrombosis in patients with intertrochanteric fracture: a retrospective study. Indian J Orthop, 2020, 54(Suppl 1): 101-108.
8. Niu S, Li J, Zhao Y, et al. Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors. BMC Musculoskelet Disord, 2021, 22(1): 264.
9. 中华医学会临床药学分会《磺达肝癸钠药学实践专家共识》编写工作组. 磺达肝癸钠药学实践专家共识. 医药导报, 2022, 41(11): 1571-1581.
10. Sun G, Wu J, Wang Q, et al. Factor Ⅹa inhibitors and direct thrombin inhibitors versus low-molecular-weight heparin for thromboprophylaxis after total hip or total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty, 2019, 34(4): 789-800. e6.
11. Bala A, Huddleston JI 3rd, Goodman SB, et al. Venous thromboembolism prophylaxis after TKA: aspirin, warfarin, enoxaparin, or factor Ⅹa inhibitors?. Clin Orthop Relat Res, 2017, 475(9): 2205-2213.
12. Yang T, Liu Z, Zhang B, et al. Comparison of the efficacy of low-molecular-weight heparin and fondaparinux sodium after total knee arthroplasty: a retrospective cohort study. BMC Musculoskelet Disord, 2023, 24(1): 552.
13. 徐厚围. 磺达肝癸钠与低分子肝素在老年髋部骨折中预防深静脉血栓的疗效比较. 南充: 川北医学院, 2023.
14. Kwong LM. Hip fracture and venous thromboembolism in the elderly. J Surg Orthop Adv, 2004, 13(3): 139-148.
15. Eriksson BI. Improvements in the prevention of postoperative venous thromboembolism in hip fracture patients. Orthopedics, 2003, 26(8 Suppl): s851-s858.
16. Eriksson BI, Bauer KA, Lassen MR, et al. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. N Engl J Med, 2001, 345(18): 1298-1304.
17. Sasaki S, Miyakoshi N, Matsuura H, et al. Prospective study on the efficacies of fondaparinux and enoxaparin in preventing venous thromboembolism after hip fracture surgery. J Orthop Sci, 2011, 16(1): 64-70.
18. 江玉, 曹燕, 王飞燕, 等. 血栓弹力图与常规凝血指标对老年创伤性骨折患者术后下肢深静脉血栓形成的预测价值分析. 中国医学前沿杂志(电子版), 2021, 13(10): 112-116.
19. 俞豪, 费杨厚雪, 闵竞, 等. RAPT 评分联合血栓弹力图 K 值及α角对创伤性骨折患者术后发生下肢深静脉血栓的诊断价值. 检验医学与临床, 2024, 21(8): 1107-1110,1117.
20. Brill JB, Badiee J, Zander AL, et al. The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography. J Trauma Acute Care Surg, 2017, 83(3): 413-419.
21. Gary JL, Schneider PS, Galpin M, et al. Can thrombelastography predict venous thromboembolic events in patients with severe extremity trauma?. J Orthop Trauma, 2016, 30(6): 294-298.
22. Brown W, Lunati M, Maceroli M, et al. Ability of thromboelastography to detect hypercoagulability: a systematic review and meta-analysis. J Orthop Trauma, 2020, 34(6): 278-286.
23. 陈潇, 李玲利, 何凌霄, 等. 血栓弹力图参数联合 D-二聚体、纤维蛋白原对老年髋部骨折患者深静脉血栓形成的预测研究. 四川医学, 2022, 43(11): 1091-1096.
24. Kumar A, Talwar A, Farley JF, et al. Fondaparinux sodium compared with low-molecular-weight heparins for perioperative surgical thromboprophylaxis: a systematic review and meta-analysis. J Am Heart Assoc, 2019, 8(10): e012184.
25. Cuker A, Arepally GM, Chong BH, et al. American society of hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv, 2018, 2(22): 3360-3392.
26. Gu ZC, Wei AH, Zhang C, et al. Risk of major gastrointestinal bleeding with new vs conventional oral anticoagulants: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2020, 18(4): 792-799. e61.
27. Lundkvist J, Bergqvist D, Jönsson B. Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery. Eur J Health Econ, 2007, 8(4): 313-323.

West China Medical Journal

Evaluation of the anticoagulant effects of low molecular weight heparin calcium and fondaparinux sodium after intertrochanteric fractures surgery by combining thromboelastography

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