Anticoagulation in Patients With a Femoral Neck Fracture: Evaluating Daily Practice.

Abstract

Background: Geriatric hip fracture patients are fragile and mostly suffering from multiple comorbidities, such as cognitive or cardiovascular disease, in which the use of antiplatelet therapy or vitamin K antagonists is common. The aim of this study is to assess the effect of antiplatelet therapy and vitamin K antagonists on perioperative care and patient outcome after hip hemiarthroplasty in daily practice.Methods: Patients with a femoral neck fracture requiring hip hemiarthroplasty were included in the study. Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records at two level II trauma centers between January 1st 2010 and May 16th 2016. Results: 907 patients (68% female) were included, with a median age of 84 (IQR 78-88), of which 415 (46%) used any sort of anticoagulation. Anticoagulation medication was associated with more packed cell supplementation; 0.33 units (±0.88) vs. 0.15 units (±0.61) (P=<0.001). Also, more hematoma’s were found for patients with anticoagulation, 19.5% versus 11.4%, P= 0.001. Patients using vitamin K antagonists needed more days to be ready for discharge compared to patients without anticoagulation, 5.5 days (4-9) versus 4 days (3-7), P = < 0.001.There was no significant difference in 30-day or 1-year mortality after surgery, nor in time to surgery. Conclusion: Patients using any sort of anticoagulation are in need of more packed cell supplementation, develop more hematomas and need more days to be ready for discharge, compared to patients without anticoagulation use. Also prolonged time to surgery was found for patients using vitamin K antagonists.

Proximal femur fractures in patients taking anti-coagulants: has anything changed?

“…Van Rijckevorsel et al, have published their observational cohort study, in which they reported an increased incidence of haematomas associated with VKAs compared to antithrombotic agents (29). Overall, the literature supports the view that patients on warfarin are more likely to have a delayed time to surgery (27,28,29). However, delayed surgical treatment is associated with increased post-operative mortality (30,31).…”