Key result
Operating on hip fracture patients with an elevated INR (1.5-3.0) resulted in significantly more postoperative anemia, but no significant difference in odds of reoperation or overall complications.
Why the study?
Surgery for geriatric hip fracture patients is often delayed to optimize INR to reduce hematological risks, though evidence suggests full reversal protocols may not be necessary.
Does operating with an elevated INR (1.5-3.0) increase postoperative complications in geriatric hip fracture patients on chronic Coumadin compared to normal INR?
Cohort (n=217)
Yes
Does operating with an elevated INR (1.5-3.0) increase postoperative complications in geriatric hip fracture patients on chronic Coumadin compared to normal INR?
Operating on hip fracture patients with an INR of 1.5-3.0 does not significantly increase reoperation or overall complications, though it is associated with more postoperative anemia.
May support timely hip fracture surgery without INR reversal in select geriatric patients on warfarin; leaves open need for RCTs to confirm safety.
In current clinical practice, orthopedic surgeons often delay the surgery intervention on geriatric hip fracture patients to optimize the international normalized ratio (INR), in order to decrease the risk of postoperative hematological complications. However, some evidence suggests that full reversal protocols may not be necessary, especially for patients with prior thromboembolic history. Our study aims to compare the surgical outcomes of patients with normal versus elevated INR values. We conducted a retrospective chart review on 217 patients who underwent surgeries on hip fractures at two academic trauma centers. We found that in our group (n = 124) of patients with an INR value of 1.5-3.0, there was only one reoperation for a hematoma, but there was a trend for more blood transfusions. There was no statistically significant difference in the odds of reoperation or overall complications. Nevertheless, there were significantly more events of postoperative anemia in this high INR patient group.
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Kain et al. (2020) conducted a cohort in Hip fractures (n=217). Elevated operative INR (1.5-3.0) vs. Normal INR values was evaluated on Reoperation or overall complications. Operating on hip fracture patients with an elevated INR (1.5-3.0) resulted in significantly more postoperative anemia, but no significant difference in odds of reoperation or overall complications.
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