Hip Fracture Surgery Arterial and Venous Thrombotic Events Prevention

Summary

A third of patients undergoing surgery for a hip fracture develop a myocardial injury (i.e., an elevated troponin measurement), and these patients are at substantial risk of death and morbidity. Current prophylaxis strategies focus on preventing venous thromboembolism (VTE); however, arterial events are more common and carry a poor prognosis. The association of acetylsalicylic acid (ASA) 75-100 mg once daily and rivaroxaban 2.5 mg twice a day (the regimen used in the COMPASS trial) might prevent both VTE and arterial cardiovascular events. Among patients who have undergone hip fracture surgery and have evidence of myocardial injury, to explore the feasibility of a randomized controlled trial (RCT) comparing rivaroxaban 2.5 mg twice daily + low-dose ASA (75-100 mg) for 90 days, with standard VTE thromboprophylaxis for 30 days, for prevention of major cardiovascular events. The HIPSTER-Pilot is a multicenter, international, open-label, pilot RCT with blinded outcome adjudication. A total of 100 participants aged ≥45 years who received hip fracture surgery and experienced a myocardial injury will be randomized to receive either rivaroxaban 2.5 mg twice daily plus ASA 75-100 mg daily for 90 days or standard VTE prophylaxis with an anticoagulant for 30 days. The primary feasibility outcome will be the recruitment rate. Other feasibility measures include completeness of follow-up and adherence to the treatment. Exploratory clinical outcomes will be assessed. This pilot trial will provide information on the feasibility of conducting a larger RCT to evaluate the efficacy and safety of the COMPASS regimen for preventing arterial and venous thrombotic events after hip fracture surgery in patients who have had myocardial injury. The results of this feasibility study will inform the design of the full-scale trial.

Conditions

• Hip Fracture Surgery
• Cardiovascular Prevention
• Venous Thromboembolism (VTE)

Interventions

DRUG

rivaroxaban and ASA

rivaroxaban 2.5 mg orally BID and ASA 75-100 mg OD for 90 days

DRUG

Low-molecular weight heparin

Enoxaparin: 40 mg subcutaneously OD (or 30 mg subcutaneously BID); Dalteparin: 5000 IU subcutaneously OD (or alternative dosing based on institutional protocol); Tinzaparin: 4500 IU subcutaneous OD

DRUG

Fondaparinux

2.5 mg subcutaneously OD

DRUG

Direct Oral Anticoagulant (DOAC)

Rivaroxaban 10 mg OD or apixaban 2.5 mg BID, started after surgery or after a period of LMWH.

Sponsors & Collaborators

• Canadian Venous Thromboembolism Clinical Trials and Outcomes Research (CanVECTOR) Network

  collaborator NETWORK

• International Network of VENous Thromboembolism Clinical Research Networks

  collaborator UNKNOWN

• McMaster University

  lead OTHER

Principal Investigators

• Federico Germini, Doctor of Medicine · McMaster University

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

45 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-12-01

Primary Completion

2027-07-01

Completion

2027-12-01

Countries

• Canada
• Italy

Study Locations