Partial warfarin reversal prior to hip fracture surgical intervention in geriatric trauma patients effects on blood loss and transfusions.

Autor: Meinig R; Orthopedic Surgery and Trauma, Penrose Hospital, 1263 Lake Plaza Dr, Colorado Springs, CO, 80906, USA., Cornutt D; Emergency Medicine, Regional West Medical Center, 4021 Avenue B, Scottsbluff, NE, 69361, USA., Jarvis S; Injury Outcomes Network (ION) Research, 501 E. Hampden Ave, Englewood, CO, 80113, USA., Salottolo K; Injury Outcomes Network (ION) Research, 501 E. Hampden Ave, Englewood, CO, 80113, USA., Kelly M; Orthopedic Surgery and Trauma, Penrose Hospital, 1263 Lake Plaza Dr, Colorado Springs, CO, 80906, USA., Harrison P; General, Trauma, & Orthopedic Surgery, Wesley Medical Center, 3242 E. Murdock Street, Wichita, KS, 67208, USA., Nentwig M; General, Trauma, & Orthopedic Surgery, Wesley Medical Center, 3242 E. Murdock Street, Wichita, KS, 67208, USA., Morgan S; Orthopedic Surgery, Internal Medicine, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO, 80113, USA., Nwafo N; Orthopedic Surgery, Internal Medicine, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO, 80113, USA., McNair P; Orthopedic Sports Medicine and Trauma, St. Anthony Hospital, 11600 West 2nd Plaza, Lakewood, CO, 80228, USA., Banerjee R; Orthopaedic Trauma, Medical City Plano, 1600 Coit Rd Suite 104, Plano, TX, 75075, USA., Woods B; General Surgery, Research Medical Center, 2316 East Meyer Boulevard, Kansas City, MO, 64132, USA., Bar-Or D; Injury Outcomes Network (ION) Research, 501 E. Hampden Ave, Englewood, CO, 80113, USA.
Jazyk: angličtina
Zdroj: Journal of clinical orthopaedics and trauma [J Clin Orthop Trauma] 2020 Sep 28; Vol. 14, pp. 45-51. Date of Electronic Publication: 2020 Sep 28 (Print Publication: 2021).
DOI: 10.1016/j.jcot.2020.09.027
Abstrakt: Background: Warfarin reversal is typically sought prior to surgery for geriatric hip fractures; however, patients often proceed to surgery with partial warfarin reversal. The effect of partial reversal (defined as having an international normalized ratio [INR] > 1.5) remains unclear.
Methods: This was a retrospective cohort study. Geriatric patients (≥65 y/o) admitted to six level I trauma centers from 01/2014-01/2018 with isolated hip fractures requiring surgery who were taking warfarin pre-injury were included. Warfarin reversal methods included: vitamin K, factor VIIa, (a)PCC, fresh frozen plasma (FFP), and the "wait and watch" method. An INR of ≤ 1.5 defined complete reversal. The primary outcome was the volume of blood loss during surgery; other outcomes included packed red blood cell (pRBC) and FFP transfusions, and time to surgery.
Results: There were 135 patients, 44% partially reversed and 56% completely reversed. The median volume of blood loss was 100 mL for both those completely and partially reversed, p = 0.72. There was no difference in the proportion of patients with blood loss by study arm, 95% vs. 95%, p > 0.99. Twenty-five percent of those completely reversed and 39% of those partially reversed had pRBCs transfused, p = 0.08. Of those completely reversed 5% received an FFP transfusion compared to 14% of those partially reversed, p = 0.09. There were no statistically significant differences observed for the volume of pRBC or FFP transfused, or for time to surgery.
Conclusions: Partial reversal may be safe for blood loss and blood product transfusions for geriatric patients with isolated hip fractures. Complete warfarin reversal may not be necessary prior to hip fracture surgery, especially for mildly elevated INRs.
Competing Interests: None.
(© 2020 Delhi Orthopedic Association. All rights reserved.)
Databáze: MEDLINE
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