Anticoagulant Prophylaxis with Edoxaban for Asymptomatic Isolated Distal Deep Vein Thrombosis in Perioperative Hip Fracture Patients

Most distal deep vein thrombosis (DVT) presents a low risk of central progression and pulmonary thromboembolism (PTE), and uniform anticoagulation is not recommended. However, the perioperative period of hip fracture (HF) is associated with a high risk of DVT progression, but a therapeutic dose of anticoagulation raises concern about bleeding risk. There is no clear recommendation for anticoagulation for asymptomatic distal DVT during the perioperative period of HF. We retrospectively evaluated the appropriateness of general anticoagulant prophylaxis with edoxaban. From April 2017 to September 2022, among patients who underwent HF surgery at our hospital, 74 consecutive cases who were diagnosed with asymptomatic distal DVT were examined. Of the 52 cases receiving anticoagulant prophylaxis with edoxaban, 23 received the prophylactic standard dose (30 mg), and 29 received the prophylactic lower dose (15 mg). The duration of anticoagulation ranged from 5 to 28 days, with a median of 14 days. There were no recurrences of symptomatic venous thromboembolism (VTE) within 3 months after starting anticoagulation. This study suggests that a general perioperative prophylactic dose, rather than a therapeutic dose, can effectively suppress symptomatic VTE and enhance safety in patients with asymptomatic distal DVT developed during the perioperative period of HF. (This is a translation of Jpn J Phlebol 2025; 36: 33-38.).