BACKGROUND: Under current guidelines surgical care of hip fractures has to be initiated within 48 h which is a challenge for the management of patients on medical anticoagulation. The aim of this study was to evaluate the in-house standard operation procedure (SOP) concerning these patients. METHODS: All geriatric hip fracture patients were included in this prospective study. Data concerning medical anticoagulation and hemoglobin levels on admission and at discharge, the start and duration of surgery, transfusion rates and postoperative complications were collected RESULTS: A total of 154 (62%) out of 247 patients were on anticoagulants. Patients on acetylsalicylic acid (ASA) demonstrated a significant increase in the rate of transfusion (62%, 95% CI, range 53%-72%, p<0.05) but lost significantly less hemoglobin during hospitalization (1.25 g/dl, 95% CI 0.62-1.88g/dl, p<0.05) in comparison to the control group (40% transfused, hemoglobin loss 3.00 g/dl). Patients on phenprocoumon were operated on later (26 h versus 20 h,95% CI 22-30, p<0.001). There were no significant differences concerning complications. CONCLUSION: Under this SOP anticoagulation has no impact on complication rates after hip fracture. The increased transfusion rates under ASS can be attributed to early blood transfusions. Antagonization of coumarin with vitamin K delays surgery but seems adequate. An analysis of more patients over a longer period of time should be conducted.
BACKGROUND: Under current guidelines surgical care of hip fractures has to be initiated within 48 h which is a challenge for the management of patients on medical anticoagulation. The aim of this study was to evaluate the in-house standard operation procedure (SOP) concerning these patients. METHODS: All geriatric hip fracturepatients were included in this prospective study. Data concerning medical anticoagulation and hemoglobin levels on admission and at discharge, the start and duration of surgery, transfusion rates and postoperative complications were collected RESULTS: A total of 154 (62%) out of 247 patients were on anticoagulants. Patients on acetylsalicylic acid (ASA) demonstrated a significant increase in the rate of transfusion (62%, 95% CI, range 53%-72%, p<0.05) but lost significantly less hemoglobin during hospitalization (1.25 g/dl, 95% CI 0.62-1.88g/dl, p<0.05) in comparison to the control group (40% transfused, hemoglobin loss 3.00 g/dl). Patients on phenprocoumon were operated on later (26 h versus 20 h,95% CI 22-30, p<0.001). There were no significant differences concerning complications. CONCLUSION: Under this SOP anticoagulation has no impact on complication rates after hip fracture. The increased transfusion rates under ASS can be attributed to early blood transfusions. Antagonization of coumarin with vitamin K delays surgery but seems adequate. An analysis of more patients over a longer period of time should be conducted.
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Authors: Giuseppe G L Biondi-Zoccai; Marzia Lotrionte; Pierfrancesco Agostoni; Antonio Abbate; Massimiliano Fusaro; Francesco Burzotta; Luca Testa; Imad Sheiban; Giuseppe Sangiorgi Journal: Eur Heart J Date: 2006-10-19 Impact factor: 29.983
Authors: J Magaziner; E Lydick; W Hawkes; K M Fox; S I Zimmerman; R S Epstein; J R Hebel Journal: Am J Public Health Date: 1997-10 Impact factor: 9.308
Authors: Lois E Wehren; William G Hawkes; J Richard Hebel; Denise Orwig; Sheryl I Zimmerman; Kathleen M Fox; Janet Yu-Yahiro; Jay Magaziner Journal: Osteoporos Int Date: 2003-12-05 Impact factor: 4.507
Authors: Jorge Cuenca Espiérrez; José Antonio García Erce; Angel A Martínez Martín; Víctor Manuel Solano; Francisco Javier Modrego Aranda Journal: Med Clin (Barc) Date: 2004-09-11 Impact factor: 1.725
Authors: P H S Kalmet; B B Koc; B Hemmes; R H M Ten Broeke; G Dekkers; P Hustinx; M G Schotanus; P Tilman; H M J Janzing; J M A Verkeyn; P R G Brink; M Poeze Journal: Geriatr Orthop Surg Rehabil Date: 2016-05-02