Proximal Femoral Fractures and Anticoagulation Therapy - When Is Surgery Safe?

CURRENT CONCEPTS REVIEW SOUBORN REFERTcation and co-morbidities and not by preoperative delay, whereas early surgery prevented surgical complications and reduced length of stay (36).Therefore, for medico-legal reasons proximal femoral fractures should be treated as early as possible even in patients with preexisting oral anticoagulation, as the complication rate and the outcome correlated with the time to surgery (28). Anticoagulative medicationThere is a widespread use of additive anticoagulative medication in patients with proximal femoral fractures.35.7% of patients suffer aspirin and clopidogrel, and 10% are on Marcumar (Phenprocoumon) medication at the time of injury (35).Others reported an overall incidence of preoperative anticoagulation in 62.3%.40.9% of patients were treated with acetylsalicylic acid, 16.2% with Phenprocoumon, 2.4% with clopidogrel and further 2.4% had a combination of several anti-coagulants (6).The effect of anticoagulants in this patient group is of tactical relevance regarding timing of surgery (6): the transfusion probability of approximately 50% can be expected in patients with proximal femur fractures, patients receiving clopidogrel medication or a combined anticoagulant medication often have surgical delay, patients receiving clopidogrel medication or a combined anticoagulant medication showed highest transfusion rates.