Is anticoagulation reversal necessary prior to surgical treatment of geriatric hip fractures?

Autor: Meinig R; Orthopedic Trauma, Penrose Hospital, 2222 North Nevada Ave, Colorado Springs, CO, 80907, USA., Jarvis S; Trauma Department, ION Research, 383 Corona St. #319, Denver, CO, 80218, USA., Orlando A; Trauma Department, ION Research, 383 Corona St. #319, Denver, CO, 80218, USA., Nwafo N; Internal Medicine, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO, 80113, USA., Banerjee R; Orthopedic Surgery, Medical City Plano, 3901 West 15th Street, Plano, TX, 75075, USA., McNair P; Orthopedic Trauma, St. Anthony's Hospital, 11600 West 2nd Place, Lakewood, CO, 80228, USA., Woods B; Surgery Research Medical Center, 2316 East Meyer Blvd, Kansas City, MO, 64132, USA., Harrison P; Trauma Surgery, Wesley Medical Center, 550 N. Hillside St., Wichita, KS, 67214, USA., Nentwig M; Orthopedic Surgery, Wesley Medical Center, 550 N. Hillside St., Wichita, KS, 67214, USA., Kelly M; Orthopedic Trauma, Penrose Hospital, 2222 North Nevada Ave., Colorado Springs, CO, 80907, USA., Smith W; Orthopedic Trauma, Swedish Medical Center, 501 E Hampden Ave., Englewood, CO, 80113, USA., Bar-Or D; Trauma Department, ION Research, 383 Corona St. #319, Denver, CO, 80218, USA.
Jazyk: angličtina
Zdroj: Journal of clinical orthopaedics and trauma [J Clin Orthop Trauma] 2020 Feb; Vol. 11 (Suppl 1), pp. S93-S99. Date of Electronic Publication: 2019 Oct 15.
DOI: 10.1016/j.jcot.2019.10.004
Abstrakt: Objective: Hip fracture surgery in geriatric patients on anticoagulants may increase the risk for blood loss. Anticoagulation reversal may lower these risks; however, data on blood loss and transfusions are limited. The study purpose was to compare outcomes between hip fracture patients 1) not on anticoagulants 2) whose anticoagulants were reversed, and 3) whose anticoagulants were not reversed.
Methods: This four-year retrospective cohort study at six Level 1 Trauma Centers enrolled geriatric patients (≥65) with isolated hip fractures. The primary outcome was total hospital blood loss (ml). Secondary outcomes: hospital length of stay (HLOS) and volume of packed red blood cells (pRBC) transfusions (ml). Statistical analyses included: Fisher's, chi-squared, Kruskal-Wallis, linear mixed-effect and logistic regression. Bonferroni adjusted alpha = 0.025.
Results: Of the 459 patients, 189 (41%) were not on anticoagulants, 186 (41%) were reversed, and 84 (18%) were not reversed. The LS mean (SE) blood loss was 134 ml (12) for not reversed patients and 159 (17) for reversed patients; no significant difference compared to those not on anticoagulants [138 (12)], p-diff = 0.14 and 0.83, respectively. The LS mean (SE) HLOS was significantly longer for the reversed patients, 7.7 (0.4) days, when compared to those not on anticoagulants, 6.8 (0.4), p = 0.02, and when compared to those not reversed, 6.3 (0.6), p = 0.01. There was no significant difference in pRBC transfusions.
Conclusion: Not reversing anticoagulants for geriatric hip fractures was not associated with increased volume of blood loss or transfusions when compared to those reversed. Delayed surgery for anticoagulant reversal may be unnecessary and contributing to an increased HLOS.
Competing Interests: The authors declare there are no financial conflicts of interest to disclose.
(© 2019 The Author(s).)
Databáze: MEDLINE
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