The role of ginkgo leaf extract and dipyridamole adjuvant treatment for reduction of lower limb deep vein thrombosis after proximal femoral nail antirotation surgery in elderly patients with intertrochanteric femoral fracture.

INTRODUCTION

Postoperative lower limb deep vein thrombosis (DVT) remains a critical complication following proximal femoral nail antirotation (PFNA) surgery for intertrochanteric femoral fracture (IFF) in the elderly. This study aimed to assess the efficacy of adjuvant Ginkgo Leaf Extract and Dipyridamole (GLED) therapy in reducing DVT incidence.

METHODS

This retrospective cohort study included elderly patients with intertrochanteric fractures treated with PFNA between August 2018 and July 2022. Patients were divided into a conventional group receiving rivaroxaban and a GLED group receiving rivaroxaban plus GLED. Evaluations included DVT incidence (postoperative days 0-7, 8-14, 15-21) and measurements of coagulation parameters, hemorheological parameters, and inflammatory markers at 8 h and 7 days post-surgery.

RESULTS

The analysis involved 227 patients (126 conventional, 101 GLED). The DVT incidence in the GLED group was significantly lower at 8-14 days (4.08% vs. 12.71%; p = 0.047) and 15-21 days (1.06% vs. 11.65%; p = 0.007). At 7 days, the GLED group showed significantly prolonged activated partial thromboplastin time (31.75 s vs. 31.24 s; p = 0.020) and prothrombin time (13.75 s vs. 13.52 s; p = 0.012), lower fibrinogen (3.18 g/L vs. 3.85 g/L; p < 0.001) and D-dimer (225.41 μg/L vs. 338.74 μg/L; p < 0.001), reduced blood viscosity (low shear: 13.14 vs. 15.26 mPa·s; p < 0.001), and decreased inflammatory markers (Interleukin-8: 21.29 vs. 22.62 pg/mL; p = 0.002).

CONCLUSION

Adjuvant GLED therapy is associated with a significantly lower subacute DVT incidence after PFNA in this retrospective cohort. Further prospective studies are required to confirm a causal relationship.