The Hip Fracture Patient on Warfarin: Evaluating Blood Loss and Time to Surgery
| Autor: | David S. Wellman, Dean G. Lorich, Matthew R. Cohn, Nikunj N. Trivedi, John P. Lyden, Joseph M. Lane, Jordan C. Villa, Ashley E. Levack |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Blood transfusion Arthroplasty Replacement Hip medicine.medical_treatment Blood Loss Surgical Tertiary Care Centers Injury Severity Score 0302 clinical medicine Orthopedics and Sports Medicine 030212 general & internal medicine 030222 orthopedics Hip fracture Trauma center Age Factors General Medicine Middle Aged Fracture Fixation Intramedullary Treatment Outcome Anesthesia Female medicine.drug medicine.medical_specialty Risk Assessment Statistics Nonparametric Time-to-Treatment 03 medical and health sciences Sex Factors medicine Humans Blood Transfusion International Normalized Ratio Adverse effect Aged Retrospective Studies Hip Fractures business.industry Warfarin Anticoagulants Retrospective cohort study Emergency department medicine.disease Surgery Logistic Models Case-Control Studies Multivariate Analysis Hemiarthroplasty business Complication Follow-Up Studies |
| Zdroj: | Journal of Orthopaedic Trauma. 31:407-413 |
| ISSN: | 0890-5339 |
| Popis: | OBJECTIVES To compare blood loss, delay of surgery, and short-term adverse events in (1) patients admitted on warfarin versus nonanticoagulated controls and (2) warfarin patients with day of surgery (DOS) international normalized ratio (INR) of 1.5 or greater versus below 1.5. DESIGN Retrospective cohort. SETTING Academic Level I trauma center. PATIENTS/PARTICIPANTS One hundred twenty four patients treated surgically for hip fractures including patients presenting on warfarin (n = 62) and matched controls (n = 62). INTERVENTION Cephalomedullary nailing (CMN), hemiarthroplasty, or total hip arthroplasty. MAIN OUTCOME MEASURES The primary outcome was transfusion rate. Secondary outcomes included calculated blood loss, 30-day complication rate, and hours from emergency department presentation to surgery. RESULTS There was no significant difference in blood transfusion rates between the warfarin and control groups (P = 0.86). Blood transfusion was required in 58.1% of patients in the warfarin group (48.3% of arthroplasties and 65.5% of CMNs) compared with 56.6% of controls (41.9% of arthroplasties and 73.3% of CMNs). There were also no significant differences in calculated blood loss or in complication rates. Patients on warfarin had significantly longer time to surgery (P < 0.01). Subanalysis of the warfarin group showed that patients with DOS INR at or above 1.5 had similar transfusion rates, blood loss, and complications compared with patients with INR below 1.5. Treatment with CMN was the only covariate that was found to be a significant independent predictor of transfusion on multivariable analysis (P = 0.048). CONCLUSIONS Patients with hip fractures admitted on warfarin seem to be at similar risk of transfusion or adverse events compared with nonanticoagulated patients. Awaiting normalization of INR delayed surgery without reducing bleeding or preventing complications. Within reason, surgeons may consider proceeding with surgery in patients with INR above 1.5 if patients are otherwise medically optimized. The upper limit above which surgery causes increased blood loss is currently unknown. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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