Key result
Patients using anticoagulation prior to hip hemiarthroplasty developed significantly more hematomas (19.5% vs 11.4%) and required more packed cell supplementation than those without anticoagulation.
Why the study?
Geriatric hip fracture patients frequently use antiplatelet therapy or vitamin K antagonists due to comorbidities, but their effect on perioperative care and outcomes after hip hemiarthroplasty needed assessment in daily practice.
Does anticoagulation therapy affect perioperative outcomes in patients undergoing hip hemiarthroplasty for femoral neck fracture?
Cohort (n=907)
Yes
Does anticoagulation therapy affect perioperative outcomes in patients undergoing hip hemiarthroplasty for femoral neck fracture?
Absolute Event Rate: 19.5% vs 11.4%
p-value: p=0.001
In geriatric patients undergoing hip hemiarthroplasty, prior use of anticoagulation is associated with increased bleeding complications and delayed discharge despite preoperative INR correction.
Prior anticoagulation was associated with more hematomas after hip hemiarthroplasty; prospective studies needed to guide perioperative management.
Background: Geriatric hip fracture patients are fragile and mostly suffering from multiple comorbidities, such as cognitive or cardiovascular disease, in which the use of antiplatelet therapy or vitamin K antagonists is common. The aim of this study is to assess the effect of antiplatelet therapy and vitamin K antagonists on perioperative care and patient outcome after hip hemiarthroplasty in daily practice.Methods: Patients with a femoral neck fracture requiring hip hemiarthroplasty were included in the study. Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records at two level II trauma centers between January 1st 2010 and May 16th 2016. Results: 907 patients (68% female) were included, with a median age of 84 (IQR 78-88), of which 415 (46%) used any sort of anticoagulation. Anticoagulation medication was associated with more packed cell supplementation; 0.33 units (±0.88) vs. 0.15 units (±0.61) (P=<0.001). Also, more hematoma’s were found for patients with anticoagulation, 19.5% versus 11.4%, P= 0.001. Patients using vitamin K antagonists needed more days to be ready for discharge compared to patients without anticoagulation, 5.5 days (4-9) versus 4 days (3-7), P = < 0.001.There was no significant difference in 30-day or 1-year mortality after surgery, nor in time to surgery. Conclusion: Patients using any sort of anticoagulation are in need of more packed cell supplementation, develop more hematomas and need more days to be ready for discharge, compared to patients without anticoagulation use. Also prolonged time to surgery was found for patients using vitamin K antagonists.
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Rijckevorsel et al. (2020) conducted a cohort in Femoral neck fracture requiring hip hemiarthroplasty (n=907). Anticoagulation (vitamin K antagonists or antiplatelet therapy) vs. No anticoagulation was evaluated on Incidence of hematoma (p=0.001). Patients using anticoagulation prior to hip hemiarthroplasty developed significantly more hematomas (19.5% vs 11.4%) and required more packed cell supplementation than those without anticoagulation.
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