Difference in Mortality Rate by Type of Anticoagulant in Elderly Patients with Cardiovascular Disease after Hip Fractures

Han, Yong; Lee, Yong Seuk; Koo, Kyung Hoi; Wi, Chankuk; Lee, Kyung Hag

doi:10.4055/cios.2019.11.1.15

Cited by 16 publications

(13 citation statements)

References 26 publications

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“…In accordance to our ndings Cha et al in 2018 also found that even thrombocyte aggregation inhibitors, such as aspirin, were associated with more packed cell supplementation. (16) This is possible due to the duration of the effect of thrombocyte aggregation inhibitors, which last during the entire lifespan of the platelets, which is usually 5 to 9 days. (17) Since prolonged hospital stay is associated with complications such as pneumonias and decubital ulcers, a stay as short as possible is desirable for these fragile patients.…”

Section: Discussionmentioning

confidence: 99%

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

Rijckevorsel

Jong²,

Klem³

et al. 2020

Preprint

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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.

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Section: Discussionmentioning

confidence: 99%

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

Rijckevorsel

Jong²,

Klem³

et al. 2020

Preprint

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“…Approximately 30-50% of patients with hip fractures have cardiovascular comorbidity that requires antithrombotic treatment (antiplatelet, vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs) [126]. Early surgery (within 48 h) has been proven to reduce complications and mortality at 30 days and 1 year in hip fracture patients even if receiving antithrombotic treatment [127][128][129], although these drugs can potentially interfere with regional anaesthesia or increase perioperative bleeding. Choosing the optimal moment for surgery should thus balance thrombotic and bleeding risks with the risks of delayed surgery and the benefits and risks of spinal anaesthesia.…”

Section: Perioperative Antithrombotic Managementmentioning

confidence: 99%

Orthogeriatric Care: Reviewing Improvements in Outcomes

Tarazona-Santabalbina¹,

Ojeda-Thies²,

Rodríguez³

et al. 2021

Preprint

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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“…2 Stable intertrochanteric fractures 3 can be managed with osteosynthesis with consistent successful outcomes, while unstable intertrochanteric fractures (UIF) are more difficult to handle due to the difficulties of achieving anatomical reduction and related comorbid conditions that raise the risk of morbidity and mortality 4,5 In the elderly, an hip fractures are associated with a 20% mortality rate. 6 Intertrochanteric femur fractures account for 50% of all hip fractures resulting from a low-energy mechanism, like a fall from standing height. Attempts to repair these fractures sometimes result in excessive collapse, poor bone quality, loss of fixation, and latency screw cut-out.…”

Section: Introductionmentioning

confidence: 99%

Is Cemented Bipolar Hemiarthroplasty Good Choice for Unstable Intertrochanteric Fractures in Elderly: Multicenteric Prospective Study at Karachi

Rajput

Memon

Azam³

et al. 2022

J Ayub Med Coll Abbottabad

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Background: To analyse the functional outcome of primary cemented bipolar hemi arthroplasty (PCBH) for unstable osteoporotic intertrochanteric femur fractures in elderly patients. Methods: It was a multicentre prospective study conducted at Institute of Orthopaedics & Surgery, Medicare Cardiac & General Hospital and Dr Ruth K M Pfau Civil Hospital Karachi, Pakistan from February 2015 to July 2020. Thirty-eight patients of 60–90 years of either gender diagnosed as close UIF, severe osteoporosis as per Singh index grade ≤3, time since injury <2 weeks, ASA status II & III and pre-injury independent walking were enrolled in this study. All patients with UIF underwent PCBH. The radiographs were performed before surgery and at intervals postoperatively. All patients were requested to come for follow up visits at 2 weeks, 4 weeks, 3 months, 6 months 1 year and then at 3 years to assess the functional outcome of patients. At first postoperative day check X-rays taken and rehabilitation started as per institutional rehabilitation protocol, at 2-week stiches removed, at 4 weeks’ x-ray was done and all the patients were followed for 3 years. The primary outcomes were noted using Harris Hip Score (HHS) for the functional outcome assessed at the end of 1 year and at final follow up. Results: The mean age of the study participants was 68.29±8.04 years. One male (2.6%) died at 6th month, then 2 females (5.2%) patients died at 1 year and 2 females (5.2%) patients died at the end of 3 years due to multiple comorbid conditions. During 1st year 3 patients (7.4%) developed DVT and 4 patients (10.5%) having diabetes and hypertension developed superficial wound infection. The mean Harris Hip Score between time points which indicated that the mean Harris Hip Score significantly improve over the period of time (p=0.001). Post hoc tests revealed that there were statistically significant differences between each time points (p<0.05). The functional outcome at 3 years, shown, one patient had excellent outcome, 24 patients had good outcome and 8 had fair outcome, respectively. Conclusion: The Primary Cemented Bipolar Hemiarthoplasty is a good choice of treatment in terms of reasonable functional outcome such as early mobilization and associated with less post-operative complications in elderly patients of UIF.

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Difference in Mortality Rate by Type of Anticoagulant in Elderly Patients with Cardiovascular Disease after Hip Fractures

Cited by 16 publications

References 26 publications

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

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

Orthogeriatric Care: Reviewing Improvements in Outcomes

Is Cemented Bipolar Hemiarthroplasty Good Choice for Unstable Intertrochanteric Fractures in Elderly: Multicenteric Prospective Study at Karachi

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