Partial warfarin reversal prior to hip fracture surgical intervention in geriatric trauma patients effects on blood loss and transfusions
| Autor: | Nnamdi Nwafo, David Bar-Or, Richard P. Meinig, Patrick McNair, David Cornutt, Paul B. Harrison, Stephanie Jarvis, Michelle Nentwig, Bradley Woods, Rahul Banerjee, Michael Kelly, Kristin Salottolo, Steven Morgan |
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| Rok vydání: | 2020 |
| Předmět: |
030222 orthopedics
Hip fracture business.industry Warfarin Retrospective cohort study Factor VIIa medicine.disease 03 medical and health sciences 0302 clinical medicine Editorial Geriatric trauma Blood loss Blood product Anesthesia Medicine Orthopedics and Sports Medicine 030212 general & internal medicine Fresh frozen plasma business medicine.drug |
| Zdroj: | J Clin Orthop Trauma |
| ISSN: | 0976-5662 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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