Key result
Chronic warfarin use in hip fracture patients was associated with higher unadjusted rates of blood transfusion (52.4% vs 43.3%, P<0.001), but was not an independent predictor on multivariable analysis.
Why the study?
The study was conducted to evaluate the effect of chronic warfarin anticoagulation on blood transfusion and postoperative complications in patients with low-energy hip fractures compared with non-anticoagulated patients.
Does chronic warfarin anticoagulation increase transfusion and postoperative complication rates in patients 55 years or older with acute hip fractures?
Cohort (n=630)
Yes
Does chronic warfarin anticoagulation increase transfusion and postoperative complication rates in patients 55 years or older with acute hip fractures?
Absolute Event Rate: 52.4% vs 43.3%
p-value: p=<0.001
Chronic warfarin use in older patients with hip fractures is associated with delayed surgery, increased transfusions, and higher 90-day complication rates, though it may not be an independent predictor.
Should not yet alter transfusion risk assessment by warfarin status in hip fracture; leaves open independent predictor effects after adjustment.
OBJECTIVE: To evaluate the effect of warfarin on blood transfusion and postoperative complications in a low-energy hip fracture population compared with a non-anticoagulated comparison group. DESIGN: Multicenter Retrospective Cohort. SETTING: Three Urban Level I Academic Trauma Centers. PATIENTS: Acute, low-energy, native hip fractures in patients 55 years of age or older on chronic warfarin anticoagulation, propensity score matched 1:2 to non-anticoagulated hip fracture patients meeting all other inclusion criteria. MAIN OUTCOME MEASUREMENTS: Transfusion and postoperative complication rates. RESULTS: Two hundred ten anticoagulated hip fracture patients were matched to 420 nonanticoagulated patients. A higher proportion of patients required blood transfusion in the warfarin cohort (52.4% vs. 43.3%, P < 0.001), attributable mostly to the subgroup of patients undergoing arthroplasty. Warfarin patients had higher incidence of overall 90-day complications (47% vs. 38%, P = 0.039) and readmissions (31.4% vs. 8.9%, P < 0.001). Day of surgery international normalized ratio (INR) did not influence transfusions or complications among warfarin patients. Warfarin patients undergoing surgery within 24 hours had no difference in transfusions and had fewer complications compared with those undergoing surgery after 24 hours. On multivariable logistic regression analysis, warfarin use and day of surgery INR were not predictors of transfusion or complications. CONCLUSIONS: Patients on warfarin experienced longer time to surgery and higher incidence of overall transfusion and postoperative complications within 90 days of surgery. However, warfarin use and day of surgery INR was not independently associated with transfusions or complications. The reason for poorer outcomes in warfarin patients remains a topic of further investigation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Levack et al. (2022) conducted a cohort in Acute, low-energy, native hip fractures (n=630). Chronic warfarin anticoagulation vs. Non-anticoagulated was evaluated on Blood transfusion (p=<0.001). Chronic warfarin use in hip fracture patients was associated with higher unadjusted rates of blood transfusion (52.4% vs 43.3%, P<0.001), but was not an independent predictor on multivariable analysis.
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