F Dettoni1, F Castoldi2, A Giai Via3, S Parisi3, D E Bonasia3, R Rossi2. 1. SCDU Ortopedia e Traumatologia, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128, Turin, Italy. federicodettoni@tin.it. 2. Università degli Studi di Torino, SCDU Ortopedia e Traumatologia, Ospedale Mauriziano Umberto I, Turin, Italy. 3. SCDU Ortopedia e Traumatologia, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128, Turin, Italy.
Abstract
BACKGROUND: Patients undergoing surgical procedures are usually asked to discontinue any anticoagulant/antiplatelet therapy and delay surgery for at least 5 days to reduce the risk of major bleeding and spinal hematoma. AIM: The purpose of this study was to determine if this strategy is suitable for patients on anticoagulant/antiplatelet therapy affected by a hip fracture, evaluating the effect of anticoagulant/antiplatelet therapy and surgical timing on mortality and complication rates for patients affected by a hip fracture. PATIENTS AND METHODS: We performed an observational study on patients referring to our hospital for a hip fracture. We evaluated patients on warfarin, ticlopidine, and aspirin therapy matched to patients not on anticoagulant or antiplatelet therapy, out of 875 consecutive patients treated for a hip fracture in a 5-year period. Blood loss, blood transfusions, length of hospitalization, walking ability, complications, and mortality at 1 year of follow-up were recorded. Kruskal-Wallis, Mann-Whitney U, and logistic regression statistical tests were performed. RESULTS: Patients on warfarin therapy operated more than 5 days after admission showed significantly higher complication and mortality rates compared to all other patients. Two critical factors were identified: warfarin therapy and excessive time to surgery; these factors are not significant if taken alone, while they become a high-risk factor if taken together. CONCLUSION: The "discontinue drug, and delay surgery" strategy is not suitable for patients on anticoagulant (warfarin) therapy affected by a hip fracture.
BACKGROUND:Patients undergoing surgical procedures are usually asked to discontinue any anticoagulant/antiplatelet therapy and delay surgery for at least 5 days to reduce the risk of major bleeding and spinal hematoma. AIM: The purpose of this study was to determine if this strategy is suitable for patients on anticoagulant/antiplatelet therapy affected by a hip fracture, evaluating the effect of anticoagulant/antiplatelet therapy and surgical timing on mortality and complication rates for patients affected by a hip fracture. PATIENTS AND METHODS: We performed an observational study on patients referring to our hospital for a hip fracture. We evaluated patients on warfarin, ticlopidine, and aspirin therapy matched to patients not on anticoagulant or antiplatelet therapy, out of 875 consecutive patients treated for a hip fracture in a 5-year period. Blood loss, blood transfusions, length of hospitalization, walking ability, complications, and mortality at 1 year of follow-up were recorded. Kruskal-Wallis, Mann-Whitney U, and logistic regression statistical tests were performed. RESULTS:Patients on warfarin therapy operated more than 5 days after admission showed significantly higher complication and mortality rates compared to all other patients. Two critical factors were identified: warfarin therapy and excessive time to surgery; these factors are not significant if taken alone, while they become a high-risk factor if taken together. CONCLUSION: The "discontinue drug, and delay surgery" strategy is not suitable for patients on anticoagulant (warfarin) therapy affected by a hip fracture.
Entities:
Keywords:
Antiaggregant therapy; Anticoagulant therapy; Complications; Hip fracture; Mortality; Warfarin
Authors: Annabel Fenwick; Michael Pfann; Jakob Mayr; Iana Antonovska; Andreas Wiedl; Stefan Nuber; Stefan Förch; Edgar Mayr Journal: Int Orthop Date: 2022-07-26 Impact factor: 3.479