Abstract
Elderly patients with hip fractures are at significantly increased risk of perioperative venous thromboembolism due to multiple comorbidities, functional decline, and prolonged immobilization. Balancing effective thromboprophylaxis with minimizing bleeding risk and improving adherence remains a core challenge in clinical management. Low-molecular-weight heparin (LMWH) is the conventional prophylactic agent, but its injectable administration often results in poor compliance. Rivaroxaban, an oral factor Xa inhibitor, has shown promise; however, clinical evidence in elderly populations remains insufficient. This study aimed to compare the efficacy and safety of rivaroxaban versus LMWH in elderly patients with hip fractures during the perioperative period. A total of 100 elderly hip fracture patients admitted between January 2022 and January 2025 were enrolled and assigned to either the LMWH group (n = 50) or the rivaroxaban group (n = 50). Baseline characteristics, including age, sex, body mass index, blood pressure, heart rate, comorbidities, and surgical methods, showed no significant differences between groups (P > .05). Perioperative outcomes compared included incidence of venous thrombosis, bleeding complications, mortality, medication adherence, and postoperative recovery. The incidence of deep vein thrombosis was significantly lower in the rivaroxaban group compared with the LMWH group (4.0% vs 10.0%, P = .03), with a higher thrombosis-free survival rate confirmed by Kaplan-Meier analysis. The overall bleeding event rate was comparable (8.0% vs 6.0%, P = .75), with no severe bleeding in either group. Thirty-day mortality was low in both groups without significant difference (4.0% vs 2.0%, P = .69). Rivaroxaban demonstrated slightly better adherence (nonadherence rate 2.0% vs 6.0%, P = .12). Postoperative recovery was more favorable in the rivaroxaban group, with shorter hospital stay (9.2 ± 2.3 vs 10.1 ± 2.5 days, P = .04) and earlier 1st ambulation (3.8 ± 1.2 vs 4.4 ± 1.3 days, P = .036), while wound healing time did not differ significantly. Rivaroxaban provides superior antithrombotic efficacy compared with LMWH in elderly hip fracture patients during the perioperative period, with comparable safety, better treatment adherence, and enhanced postoperative recovery. These findings suggest rivaroxaban may represent a preferred prophylactic option in this high-risk population, although larger multicenter trials with longer follow-up are warranted to validate its clinical utility.