Priority 16 from the Complex Fractures PSP

NG89 includes a review of 15 studies, 13 of which were randomised controlled trials. Where pharmacological or mechanical prophylaxis was compared with no prophylaxis, there were better outcomes in the group receiving an intervention. The NICE committee considered that the evidence sufficiently supported the use of Low Molecular Weight Heparin and Fondaparinux. The listed randomised controlled trial supports use of aspirin alone, however NICE committee felt inadequate evidence on bleeding risk and therefore this was listed as a research recommendation. There was a lack of evidence evaluating Direct Oral Anticoagulants in this review population.

A 2020 Randomised Controlled Trial linked here by Haac et al. found no evidence of superiority between Low Molecular Weight Heparin or Aspirin for VTE prevention in fracture patients. Non-pharmaceutical method of VTE prophylaxis exist and include patient hydration, early mobilisation, and compression stockings.

NICE Guideline 89 Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

Aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis in orthopaedic trauma patients: A patient-centered randomized controlled trial