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643 orthopaedic surgeons were sent a questionary asking how they attempted to prevent and diagnose deep venous thrombosis (D.V.T.) in patients with hip fractures. 411 (64%) replied. Of those who replied, 51% offered no prophylaxis, only 3% routinely used oral anticoagulation, and 85% relied on clinical signs in the diagnosis.

752 orthopaedic and 663 general surgeions were sent a questionnaire asking how they attempted to prevent venous thromboembolism; the survey concerned prophylaxis offered routinely to elderly patients with hip fractures, to patients undergoing elective hip replacement arthroplasty, and to patients undergoing major abdominal and thoracic operations. The response rate was more than 70%. The results suggest that the provision of prophylaxis against venous thromboembolism is inversely related to the frequency with which it occurs--e.g., the proportions of surgeons offering no routine prophylaxis or ambulation and physiotherapy only was 72% for hip fractures, 52% for hip replacement, and 38% for general surgery.

In a prospective controlled randomised trial, the prophylactic value of warfarin sodium (in doses aimed at maintaining a "Thrombotest" value of 10% and given from the day of admission until independent mobility had been achieved or for 3 mo, whichever was the sooner) was assessed in 160 elderly patients who had sustained a fracture of the femoral neck. Treatment significantly reduced the frequency of deep venous thrombosis (D.V.T.), whether indicated by the 125I-fibrinogen test during life or assessed by detailed post-mortem studies. Pulmonary embolism was eliminated in treated patients, but the difference in mortality between the treatment and control groups was not significant, indicating that causes of death other than pulmonary embolism are of major importance in these elderly patients. A case is made out for prophylactic anticoagulation on a selective basis.