What question did this study set out to answer?

To assess thromboembolic and systemic complications, mortality, and time to surgery associated with the pharmacologic reversal of warfarin-induced coagulopathy in geriatric hip fracture patients.

July 1, 2011Geriatric Orthopaedic Surgery & RehabilitationOpen Access

Pharmacologic Reversal of Warfarin-Associated Coagulopathy in Geriatric Patients With Hip Fractures

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Why the study?

Does pharmacologic reversal of warfarin-associated coagulopathy with vitamin K and/or FFP reduce mortality and complications in geriatric patients with hip fractures?

Population

93 geriatric patients with operative hip fractures on oral warfarin therapy who had an international…

Comparison

Pharmacologic reversal of elevated INR with… vs Warfarin held upon admission without further…

Design

Cohort

Follow-up

3 months

Authors

MVMark A. VitaleGreenwich Hospital CVCorinne VanBeekThomas Jefferson University JSJohn SpivackHospital for Special Surgery

Discussion

Member takes

Implication

Reversal was associated with shorter surgical delay in high-INR patients; leaves open mortality benefit pending randomized trials.

Key Points

To assess thromboembolic and systemic complications, mortality, and time to surgery associated with the pharmacologic reversal of warfarin-induced coagulopathy in geriatric hip fracture patients.
Retrospective cohort study evaluating 93 geriatric patients with operative hip fractures on oral warfarin presenting with an admission international normalized ratio (INR) >1.50 over a 13-year period.
Compared a pharmacologic reversal cohort treated with vitamin K and/or fresh frozen plasma in addition to holding warfarin (n = 70) against a control cohort managed by holding warfarin alone (n = 23).
Three-month mortality was 4% in the pharmacological reversal group versus 17% in the watch-and-wait group, demonstrating a trend toward statistical significance (P = .06).
Thromboembolic and other systemic complications showed no statistically significant differences between treatment cohorts.
In patients with a baseline INR >2.17 (n = 46), pharmacologic reversal significantly reduced time to surgery by a mean difference of 4.0 fewer days (P < .01).

Structured PICO

Does pharmacologic reversal of warfarin-associated coagulopathy with vitamin K and/or FFP reduce mortality and complications in geriatric patients with hip fractures?

Population

93 geriatric patients with operative hip fractures on oral warfarin therapy who had an international normalized ratio (INR) >1.50 on admission

Intervention

Pharmacologic reversal of elevated INR with vitamin K and/or fresh frozen plasma (FFP) in addition to holding warfarin

Comparator

Warfarin held upon admission without further intervention preoperatively (watch-and-wait group)

Outcome

Thromboembolic and other complications as well as mortality within 3 months of presentationhard clinical

Pharmacological reversal of warfarin with vitamin K and/or FFP in geriatric hip fracture patients appears safe and significantly reduces time to surgery in patients with more elevated pre-operative INRs.

Cite This Study

Vitale et al. (2011) studied this question.

synapsesocial.com/papers/6a701dd626a7f98052dc9eb9 https://doi.org/10.1177/2151458511417434

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Pharmacologic Reversal of Warfarin-Associated Coagulopathy in Geriatric Patients With Hip Fractures

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Pharmacologic Reversal of Warfarin-Associated Coagulopathy in Geriatric Patients With Hip Fractures

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

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