Abstract
BackgroundGuidelines underline the importance of early surgery in elderly patients with proximal femoral fractures. However, most of these patients present a high number of comorbidities, some of which require the use of warfarin. Waiting for INR decrease is a cause of surgical delay, and this influences negatively their outcome.MethodsWe retrospectively reviewed all patients with proximal femoral fracture admitted to our unit from March 2013 to March 2017 to determine whether warfarin therapy is associated with reduction of survival, delay of surgery, and increased blood loss. From 1706 patient, a total of 1292 fulfilled the eligibility criteria and were included. Data regarding general information (type of fracture according to AO/OTA classification), pharmacological history regarding anticoagulant therapy pre-admission, surgery (type of surgery and time to surgery), clinical findings (blood loss), and date of exitus were collected.ResultsWe identified 157 patients with warfarin, 442 with antiplatelet agents (aspirin, clopidogrel, ticlopidin), and 693 in the control group. We observed a significant difference in the warfarin group regarding an increased ASA score, Charlson Comorbidity Index, and blood loss. Patients taking warfarin experience delay to the theater significantly more than the other groups. Patients in warfarin therapy have a 42% higher risk of death within 1 year from their surgery. Patients who underwent surgery after 48 h have 1.5 times higher risk of mortality with respect to the patients who underwent surgery within 48 h.ConclusionWarfarin therapy at the time of proximal femoral fractures is associated with increased time to surgery, blood loss, and mortality.
Highlights
Hip fractures are common orthopedic injury and are a major cause of morbidity and mortality in the elderly
The purpose of this study is to determine whether warfarin therapy at the time of admission for proximal femoral fracture (PFF) is associated with reduction of survival, delay of surgery, and increased blood loss
Anesthesiologists Physical Status Classification System score (ASA) score and Charlson Comorbidity Index were significantly higher in the warfarin group (p < 0.001)
Summary
Hip fractures are common orthopedic injury and are a major cause of morbidity and mortality in the elderly. One of the strategies to reduce the bleeding in these patients is to temporarily postpone the warfarin administration and wait until the anticoagulant effect of the warfarin has subsided, the action of warfarin lies between 2 and 5 days [10].The use of vitamin K to reverse the effect of warfarin has been shown to be safe and effective in the context of PFF surgery even though there is no widely accepted consensus on the absolute indications, dosage, and route of vitamin K treatment in the context of hip fracture [11]. Guidelines underline the importance of early surgery in elderly patients with proximal femoral fractures Most of these patients present a high number of comorbidities, some of which require the use of warfarin. Waiting for INR decrease is a cause of surgical delay, and this influences negatively their outcome
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