Influence of timing and oral anticoagulant/antiplatelet therapy on outcomes of patients affected by hip fractures
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : F. Dettoni F. Castoldi A. Giai Via S. Parisi D. E. Bonasia R. Rossi
- چاپ و سال / کشور: 2010
Description
Background Patients undergoing surgical procedures are usually asked to discontinue any anticoagulant/antiplatelet therapy and delay surgery for at least 5 days to reduce the risk of major bleeding and spinal hematoma. Aim The purpose of this study was to determine if this strategy is suitable for patients on anticoagulant/antiplatelet therapy affected by a hip fracture, evaluating the effect of anticoagulant/antiplatelet therapy and surgical timing on mortality and complication rates for patients affected by a hip fracture. Patients and methods We performed an observational study on patients referring to our hospital for a hip fracture. We evaluated patients on warfarin, ticlopidine, and aspirin therapy matched to patients not on anticoagulant or antiplatelet therapy, out of 875 consecutive patients treated for a hip fracture in a 5-year period. Blood loss, blood transfusions, length of hospitalization, walking ability, complications, and mortality at 1 year of follow-up were recorded. Kruskal– Wallis, Mann–Whitney U, and logistic regression statistical tests were performed. Results Patients on warfarin therapy operated more than 5 days after admission showed significantly higher complication and mortality rates compared to all other patients. Two critical factors were identified: warfarin therapy and excessive time to surgery; these factors are not significant if taken alone, while they become a high-risk factor if taken together. Conclusion The ‘‘discontinue drug, and delay surgery’’ strategy is not suitable for patients on anticoagulant (warfarin) therapy affected by a hip fracture
Eur J Trauma Emerg Surg DOI 10.1007/s00068-011-0073-x Received: 26 October 2010 / Accepted: 30 December 2010
