Individual research recommendation details

Recommendation ID

NG89/4

Question

Aspirin prophylaxis for people with fragility fractures of the pelvis, hip or proximal femur:- What is the clinical and cost effectiveness of aspirin alone versus other pharmacological and/or mechanical prophylaxis strategies (alone or in combination) for people with fragility fractures of the pelvis, hip or proximal femur?

Any explanatory notes
(if applicable)

Why this is important:- Fragility fractures are the greatest burden of musculoskeletal disease in hospitals in the UK. There are approximately 70,000 fragility hip fractures per year in England alone leading to 1.5 million bed days being used each year, which equates with the continuous occupation of over 4,000 NHS beds.
Current evidence supports a recommendation for prophylaxis with LMWH or fondaparinux. Both
involve a subcutaneous injection for 28 days requiring either self-injection at home or a community
nurse attending to deliver the injection. Patient adherence to treatment may be improved with an
oral rather than injectable treatment.
A large but controversially reported trial suggests that aspirin may be at least as effective as currently recommended treatments. However, because of methodological and reporting limitations, the evidence for the effectiveness of aspirin alone is not clear. There is potentially a large cost saving if aspirin is clinically effective because it is very inexpensive.

Source guidance details

Comes from guidance

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

Number

NG89

Date issued

March 2018

Other details