Benjamin Buecking1, Daphne Eschbach2, Christopher Bliemel2, Ludwig Oberkircher2, Johannes Struewer3, Steffen Ruchholtz2, Ulrich J Sachs4. 1. Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Campus Marburg. Electronic address: buecking@med.uni-marburg.de. 2. Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Campus Marburg. 3. Department of Orthopaedics and Rheumatology, University of Giessen and Marburg, Campus Marburg. 4. Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany; Center for Transfusion Medicine and Hemotherapy, University Hospital Giessen and Marburg, Campus Marburg.
Abstract
INTRODUCTION: Vitamin K antagonists are often used for anticoagulant treatment in hip fracture patients. The optimal handling with such anticoagulants is unclear. We aimed to determine when anticoagulation reversal occurred after vitamin K administration and how often prothrombin complex concentrates (PCCs) were administered. We compared patients' treatments and outcomes with those of a control group not receiving treatment for anticoagulation. PATIENTS AND METHODS: A total of 402 geriatric hip fracture patients were included in this observational study. We collected data on treatment for anticoagulation, time to surgery, and reasons for delay of surgery. In patients taking vitamin K antagonists, we measured the INR (international normalized ratio) on admission and prior to surgery, along with the frequency of PCC administration. Finally, we compared in-hospital mortality and complications between patient groups. RESULTS: A total of 62 (15%) patients received phenprocoumon prior to their fractures. Surgery was delayed in these patients compared to controls (27h; 95%CI 23-31 vs. 16h; 95%CI 19-19; p=0.001), but surgery delay >48h (n=5; 8%) was not due to a failure of INR reversal. The main reason for these delays was a lack of capacity for surgery. The average INR on admission was 2.1 (±0.7; range 1.0-3.5) in patients taking phenprocoumon, which decreased to 1.3 (±0.3; range 1.0-1.6) until surgery. PCCs were administered to 19% of patients. We found no differences in the in-hospital mortality (6.2% vs. 8.1%, p=0.575) or complication rates (12.9% vs. 9.4%, p=0.364). CONCLUSION: The use of vitamin K seemed to be sufficient for anticoagulation reversal in geriatric hip fracture patients, and it generally led to timely surgery; despite this success, PCCs were sometimes administered for logistical reasons.
INTRODUCTION:Vitamin K antagonists are often used for anticoagulant treatment in hip fracturepatients. The optimal handling with such anticoagulants is unclear. We aimed to determine when anticoagulation reversal occurred after vitamin K administration and how often prothrombin complex concentrates (PCCs) were administered. We compared patients' treatments and outcomes with those of a control group not receiving treatment for anticoagulation. PATIENTS AND METHODS: A total of 402 geriatric hip fracturepatients were included in this observational study. We collected data on treatment for anticoagulation, time to surgery, and reasons for delay of surgery. In patients taking vitamin K antagonists, we measured the INR (international normalized ratio) on admission and prior to surgery, along with the frequency of PCC administration. Finally, we compared in-hospital mortality and complications between patient groups. RESULTS: A total of 62 (15%) patients received phenprocoumon prior to their fractures. Surgery was delayed in these patients compared to controls (27h; 95%CI 23-31 vs. 16h; 95%CI 19-19; p=0.001), but surgery delay >48h (n=5; 8%) was not due to a failure of INR reversal. The main reason for these delays was a lack of capacity for surgery. The average INR on admission was 2.1 (±0.7; range 1.0-3.5) in patients taking phenprocoumon, which decreased to 1.3 (±0.3; range 1.0-1.6) until surgery. PCCs were administered to 19% of patients. We found no differences in the in-hospital mortality (6.2% vs. 8.1%, p=0.575) or complication rates (12.9% vs. 9.4%, p=0.364). CONCLUSION: The use of vitamin K seemed to be sufficient for anticoagulation reversal in geriatric hip fracturepatients, and it generally led to timely surgery; despite this success, PCCs were sometimes administered for logistical reasons.
Authors: Richard Meinig; David Cornutt; Stephanie Jarvis; Kristin Salottolo; Michael Kelly; Paul Harrison; Michelle Nentwig; Steven Morgan; Nnamdi Nwafo; Patrick McNair; Rahul Banerjee; Bradley Woods; David Bar-Or Journal: J Clin Orthop Trauma Date: 2020-09-28
Authors: Veronique A J I M van Rijckevorsel; Gert R Roukema; Taco M A L Klem; Tjallingius M Kuijper; Louis de Jong Journal: Geriatr Orthop Surg Rehabil Date: 2021-08-11