Objectives: To determine the time to surgery (TTS) among patients with acute hip fracture who are anticoagulated with vitamin K antagonists (VKAs) who receive prothrombic complex concentrate (PCC) compared to those who do not receive PCC.Method: We conducted a retrospective cohort study of consecutive patients with an acute hip fracture presenting to the emergency department (ED) of the Jewish General Hospital, a 637-bed tertiary care hospital center in Montreal, Quebec, between January 1st, 2015 and March 1st, 2020. Eligible patients were identified via the ED electronic database. Inclusion criteria were: (1) > 18 years of age; (2) acute hip fracture and admission for surgical repair; (3) VKA use and international normalized ratio (INR) > 1.5 at admission. Follow-up was limited to index hospitalization. The primary outcome of TTS, reported in hours, was defined as the time from hospital admission to the time of surgery. Mann-Whitney U test was used to assess any difference in median TTS between the two groups. Results: A total of 53 patients were included in our cohort of which 43.4% (23/53) received PCC with a median time to first dose of 25.5 hours (IQR 19.4-51.6). 84.9 % (45/53) received vitamin K with a median time to the first dose of 16 h (IQR 7.5-26.7). The median TTS in the PCC and no PCC groups was 51.8 h (IQR 26.8–71.4) vs. 63.5 h (IQR 49.4-73.2) respectively (p=0.71). Conclusion: This study did not identify shorter TTS between patients who received PCC and those who did not. Median TTS in both groups surpassed the recommended 48h benchmark, and PCC and vitamin K administration timing was suboptimal. These findings demonstrate a significant care gap among this vulnerable population and represent a call for future initiatives to ensure a more streamlined and multidisciplinary approach to anticoagulation management starting at the onset of presentation criteria were: (1) > 18 years of age; (2) acute hip fracture and admission for surgical repair; (3) VKA use and international normalized ratio (INR) ˃ 1.5 at admission. Follow-up was limited to index hospitalization. The primary outcome of TTS, reported in hours, was defined as time from hospital admission to time of surgery. Mann-Whitney U test was used to assess any difference in median TTS between the two groups. RésuméObjectifs: Déterminer le délai avant l’intervention chirurgicale (DAIC) parmi les patients présentant une fracture aigüe de la hanche qui suivent une anticoagulothérapie par des antagonistes de la vitamine K (AVK) et qui reçoivent un concentré de complexe prothrombique (CCP) par rapport à ceux qui ne reçoivent pas le CCP. Méthodologie: Nous avons mené une étude de cohorte rétrospective de patients consécutifs présentant une fracture aigüe de la hanche à leur arrivée à l’urgence de l’Hôpital général juif, un centre hospitalier de 637 lits de soins tertiaires situé à Montréal (Québec), entre le 1er janvier 2015 et le 1er mars 2020. Les patients admissibles ont été repérés par l’intermédiaire de la base de données électronique du service des urgences. Les critères d’inclusion sont : 1) personne âgée de plus de 18 ans; 2) fracture aiguë de la hanche et hospitalisation en vue d’une réparation chirurgicale; 3) prise d’AVK et rapport international normalisé (RIN) supérieur à 1,5 lors de l’admission à l’hôpital. Le suivi se limite à l’admission initiale. Le critère d’évaluation principal du DAIC, indiqué en heures, est défini comme étant le délai entre l’admission à l’hôpital et le moment de l’intervention chirurgicale. Le test U de Mann-Whitney est utilisé pour évaluer toute différence dans les DAIC médians entre les deux groupes. Résultats: Au total, 53 patients font partie de la cohorte dont 43,4 % (23/53) ont reçu le CCP, le délai médian avant la première dose étant de 25,5 heures (écart interquartile [EI] de 19,4 à 51,6), et 84,9 % (45/53) ont reçu de la vitamine K, le délai médian avant la première dose étant de 16 heures (EI de 7,5 à 26,7). Le DAIC médian est de 51,8 heures (EI de 26,8 à 71,4) pour le groupe recevant le CCP et de 63,5 heures (EI de 49,4 à 73,2) pour celui ne recevant pas le CCP (p = 0,71). Conclusion: Cette étude révèle une tendance vers des DAIC plus courts chez les patients recevant le CCP que chez ceux qui ne le reçoivent pas. Le DAIC médian dans les deux groupes est supérieur au délai de référence recommandé de 48  heures, et le moment où le CCP et la vitamine  K sont administrés est sous-optimal. Ces constatations montrent une lacune importante en matière de soins chez cette population vulnérable et représentent un appel à des initiatives visant à assurer une approche simplifiée et multidisciplinaire de la prise en charge de l’anticoagulothérapie qui commence dès l’arrivée du patient à l’hôpital.

Objective: There are limited reports of the clinical significance of Raynaud phenomenon (RP) in systemic lupus erythematosus (SLE), with some suggesting RP is associated with less severe lupus. Since most prior studies were small and/or focused on a specific race/ethnic demographic, it is unclear if those results are generalizable. We evaluated whether RP was associated with demographic and clinical factors in a large multiethnic SLE cohort. Methods:We studied Montreal General Hospital SLE cohort patients who are followed with standardized annual assessments. We included patients with at least 1 visit across 2011-2018 and assessed demographic and clinical variables (using the 1997 American College of Rheumatology criteria and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) at their first visit. We present multivariate logistics regression analyses of cross-sectional associations between these variables and RP in SLE.Results: Of 489 SLE patients, most were female (n = 445, 91%). Mean age at SLE diagnosis was 31.5 (standard deviation, 13.5) years, and 169 (34.6%) had RP. In our fully adjusted model, female sex (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.07-6.03), White race/ethnicity (OR, 1.85; 95% CI, 1.10-3.17), neurological/neuropsychiatric manifestations (OR, 1.98; 95% CI, 1.10-3.56), and anti-RNP antibodies (OR, 3.03; 95% CI, 1.73-5.38) were positively associated with RP, whereas hemolytic anemia and cellular casts were negatively associated.Conclusions/Discussion: Over one third of our large multiethnic North American SLE cohort had RP. This study confirmed associations between RP and a specific SLE phenotype.