DIRECT
The Delivery and Implementation of a Randomised Crossover Trial on Thrombosis (DIRECT) trial is a national NHS study looking at the best way to prevent blood clots in people who have surgery after breaking a hip.
Research overview
Blood clots can be a serious complication after hip fracture surgery, especially in older adults, and different hospitals currently use different medicines to reduce this risk.
DIRECT compares two commonly used treatments: aspirin, which is taken as a tablet, and low molecular weight heparin , which is given as a daily injection. Both are already used safely in routine care, but it is not yet clear which works best for this group of patients.
The study is for adults aged 60 and over who are treated for a hip fracture in participating NHS hospitals. By using existing NHS health records, the study aims to improve care for future patients without adding extra burden on patients or hospital staff.
Why this study matters
The DIRECT study matters because there is still uncertainty about the best way to prevent blood clots after hip fracture surgery. Hospitals across the NHS currently use different treatments, but there is limited strong evidence to show which option works best and is safest for older patients. This gap in knowledge can lead to variation in care and uncertainty for clinicians and families.
Now is the right time to answer this question because hip fractures are becoming more common as the population ages, placing increasing pressure on the NHS. The results of DIRECT could lead to clearer guidance, more consistent care and simpler treatment for patients, improving recovery and outcomes in the communities we serve.
What we are doing
DIRECT uses a cluster randomised design, where whole hospitals are allocated to use one treatment as standard care for a fixed period before switching to the other. This allows the study to reflect real-world NHS practice.
No patients are approached directly during the study, and no extra information is collected from them. Instead, outcomes are measured using existing NHS health records, such as the National Hip Fracture Database and hospital data. The trial runs over a 12-month period, with short-term outcomes assessed at 90 days and longer-term follow-up planned through routine data linkage.
Who is involved
The DIRECT study is led by Professor Xavier Griffin, who is the Chief Investigator. The study is delivered through a collaboration between Queen Mary University of London, NHS hospitals across England and Wales and national data partners including the National Hip Fracture Database NHS England and Digital Health and Care Wales .
DIRECT is funded by the National Institute for Health and Care Research Health Technology Assessment Programme, ensuring the study addresses an important NHS priority and generates evidence to inform future clinical guidelines and improve care for patients with hip fractures.
Current status
The DIRECT study is currently in the set-up phase. Regulatory approvals are in place, and the study team is now actively preparing sites and inviting participation. DIRECT is open to recruitment of NHS hospitals across England and Wales, with ongoing engagement through research networks and direct site discussions.