Pre-injury use of antiplatelet and anticoagulations therapy are associated with increased mortality in a cohort of 1038 hip fracture patients
| Autor: | A Mahmood, David H. Hawkes, David G. Whittam, WJ Harrison, Perry Maskell, Luke Thornton |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Poison control Occupational safety and health Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine Injury prevention medicine Humans General Environmental Science Retrospective Studies 030222 orthopedics Hip fracture business.industry Hip Fractures Mortality rate Warfarin Anticoagulants 030208 emergency & critical care medicine medicine.disease Cohort General Earth and Planetary Sciences business Developed country medicine.drug |
| Zdroj: | Injury. 52(6) |
| ISSN: | 1879-0267 |
| Popis: | Background Hip fractures are a large burden on the health care systems of developed nations. Patients usually have multiple co-morbidities and the pre-injury use of anticoagulants and anti-platelet medication is common. Materials and methods This study used a single hospital hip fracture database to facilitate a retrospective analysis of the impact of anti-coagulation and anti-platelet therapy on mortality and complications after surgical management of hip fractures. There were 92 patients on warfarin, 69 on DOAC, 260 antiplatelet patients and 617 control patients . Results Mortality rates at 30 days were 4.8% for the control group, 12.6% for the antiplatelet group, warfarin 7.0%, 9.5% for Direct Oral Anticoagulant (DOAC) group, p = 0.004. Mortality rates at 1 year were 22.4% for the control group, 32.3% for the antiplatelet group, 29.3% for the warfarin group and 29.0% for DOAC group (p=0.007). Amongst complications, significant differences were found in transfusion (DOAC) and wound ooze (warfarin) rates, but the study did not detect significant clinical consequences arising from these differences. A matched analysis for age, sex, and ASA was undertaken to look in more detail at mortality data. Some mortality differences remained between groups with anti-platelet medication associated with increased mortality, but the differences no longer appeared to be significant. Our data suggests that this is a non-causal association, which could be incorporated into predictive mortality risk scores such as the Nottingham hip fracture score. Conclusion We believe that pre-injury antiplatelet therapy is a strong indicator for high risk patients with higher expected mortality after hip fracture surgery. We saw no evidence to support delayed surgery in patients taking DOACs |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect