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Anticoagulant therapy in hip fracture

José Cordero, Alfonso Maldonado, Sergio Iborra
PURPOSE: Analysis of significant risk factors for mortality and for medical and orthopaedic complications. PATIENTS AND METHODS: Observational study of a prospective consecutive cohort of 697 patients diagnosed of hip fracture from December 2012 to December 2014. Average age was 85±9years and 520 were female (75%). Intracapsular fractures (308, 44%) were treated non-operatively, (19 patients), with cannulated screws (58) or with hip arthroplasty (228 bipolar, 3 total hip atrhoplasty)...
September 2016: Injury
Alejandro Lizaur-Utrilla, Daniel Martinez-Mendez, Isabel Collados-Maestre, Francisco A Miralles-Muñoz, Luis Marco-Gomez, Fernando A Lopez-Prats
PURPOSE: To analyze prospectively the influence of the timing of surgery on morbidity and mortality, and to assess whether the early surgery within 2 days admission may be a reliably healthcare quality indicator. METHODS: Prospective observational study of 628 patients age 60 or older who had been co-managed between surgeons and internists. Based on the literature, many potential factors influencing outcomes were collected to control confounding regard to surgery delay, complications and mortality...
July 2016: Injury
Francesc Formiga, David Chivite, Margarita Navarro, Abelardo Montero, Enric Duaso, Domingo Ruiz, Juan Manuel Perez-Castejon, Alfons Lopez-Soto, Xavier Corbella
OBJECTIVE: To analyze the demographic and clinical characteristics of patients on chronic anticoagulant therapy (CAT) admitted because of a hip fracture secondary to a fall, and to compare with patients not receiving CAT. METHODS: A prospective, observational study realized in six hospitals in the Barcelona area. Demographic and clinical characteristics of patients were collected. The index fall characteristics - cause, height, location, and time of occurrence - were evaluated...
June 2016: Acta Clinica Belgica
Zhongdi Liu, Na Han, Hailin Xu, Zhongguo Fu, Dianying Zhang, Tianbing Wang, Baoguo Jiang
BACKGROUND: Venous thromboembolism is a common postoperative complication following orthopedic surgeries, with morbid and potentially fatal consequences. Perioperative low-molecular-weight heparin (LMWH) therapy can reduce the incidence of venous thromboembolism, but may also increase the risk of bleeding complications. Current literature reflects the need to balance the improved efficacy of early initiating prophylaxis with increased risk of perioperative bleeding. The purpose of this study was to compare the effectiveness and hemorrhage related safety of preoperative versus postoperative LMWH therapy for prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients...
2016: BMC Musculoskeletal Disorders
F Dettoni, F Castoldi, A Giai Via, S Parisi, D E Bonasia, R Rossi
BACKGROUND: Patients undergoing surgical procedures are usually asked to discontinue any anticoagulant/antiplatelet therapy and delay surgery for at least 5 days to reduce the risk of major bleeding and spinal hematoma. AIM: The purpose of this study was to determine if this strategy is suitable for patients on anticoagulant/antiplatelet therapy affected by a hip fracture, evaluating the effect of anticoagulant/antiplatelet therapy and surgical timing on mortality and complication rates for patients affected by a hip fracture...
October 2011: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Ian Starks, Stephen Cooke, Charles Docker, Andrew Raine
INTRODUCTION: In an aging population, anticoagulation in patients with musculoskeletal injuries is increasingly prevalent. The North American literature indicates an absence of consensus concerning the most appropriate management for this group. We aim to test the hypothesis that there is a lack of consensus in the UK regarding the perioperative management of patients with hip fractures on long-term warfarin therapy. MATERIALS AND METHODS: A representative group of 400 consultant orthopedic surgeons was surveyed by postal questionnaire regarding their policy on the reversal of anticoagulation in warfarinized patients with hip fractures...
June 2009: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Filippo Calderazzi, Massimo Pompili, Antonio Carolla, Paolo Schiavi, Giulia Groppi, Francesco Ceccarelli
AIM OF THE WORK: This study analyzes the clinical and radiographic results of 100 patients who underwent osteosynthesis with Gamma nail™, following fracture of the pertrochanteric region. METHODS: These patients were divided into 2 groups: A, those without anatomical reduction of the fracture and B, those with anatomical reduction. All patients were classified according to the ASA system, pre-injury and follow-up Harris Hip Score and pre-operative/post-operative radiographic evaluation...
2015: Acta Bio-medica: Atenei Parmensis
Thomas Steven Moores, Alastair Beaven, Andrew Edwin Cattell, Charles Baker, Philip John Roberts
PURPOSE: To evaluate our hospital protocol of low-dose vitamin K titration for preoperative warfarin reversal for early hip fracture surgery. METHODS: Records of 16 men and 33 women aged 63 to 93 (mean, 81) years who were taking warfarin for atrial fibrillation (n=40), venous thromboembolism (n=9), cerebrovascular accident (n=3), and prosthetic heart valve (n=3) and underwent surgery for hip fractures were reviewed. The 3 patients with a prosthetic heart valve were deemed high risk for thromboembolism and the remainder low-risk...
April 2015: Journal of Orthopaedic Surgery
Timo Purmonen, Soili Törmälehto, Niina Säävuori, Hannu Kokki
BACKGROUND: Hip fractures require operation within 36-48 h, and they are most common in the elderly. A high International Normalized Ratio should be corrected before surgery. In the current study, we analyzed the budget impact of various warfarin reversal approaches. METHODS: Four reversal strategies were chosen for the budget impact analysis: the temporary withholding of warfarin, administration of vitamin K, fresh frozen plasma (FFP), and a four-factor prothrombin complex concentrate (PCC)...
March 2015: Drugs in R&D
Anhua Long, Lihai Zhang, Yingze Zhang, Baoguo Jiang, Zhi Mao, Hongda Li, Shanbao Zhang, Zongyan Xie, Peifu Tang
Thromboprophylaxis with rivaroxaban has proved effective and safe in patients undergoing hip and knee replacement surgery. As it is unclear whether it is also effective and safe in fracture patients, the aim of the present study was to evaluate the efficacy and safety of rivaroxaban in patients with lower limb fractures. We performed a retrospective cohort study of 2,050 consecutive patients treated for lower limb fractures at our trauma center, comparing rates of venous thromboembolism (VTE), bleeding and surgical complications, and the length of hospital stay for 608 patients who received rivaroxaban and 717 who received a low-molecular-weight heparin (LMWH)...
October 2014: Journal of Thrombosis and Thrombolysis
I Ahmed, M A Khan, V Nayak, A Mohsen
BACKGROUND: Up to 4% of patients presenting with a hip fracture may be on warfarin at admission. There is little consensus on the timing, dosage or route of vitamin K administration. We aimed to evaluate the impact of a locally developed, evidence-based protocol for perioperative warfarin management on the admission-to-operation time (AOT) in hip fracture patients. MATERIALS AND METHODS: Clinical and demographic data were collected prospectively for hip fracture patients who were on warfarin at the time of admission (post-protocol group) and compared to a historical control group of patients who were on warfarin before implementation of the protocol (pre-protocol group)...
March 2014: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
Colin Prensky, Adriana Urruela, Michael S Guss, Raj Karia, Tory J Lenzo, Kenneth A Egol
INTRODUCTION: In the prevention of venous thrombo-embolic events (VTEs) in isolated low-energy fracture patients, management guidelines are conflicting and prior literature is lacking. We aimed to determine the incidence and factors associated with the development of symptomatic VTE in this patient cohort. MATERIALS AND METHODS: To identify patients with isolated, low-energy fractures, we studied billing records from all admissions to our tertiary care orthopaedic hospital from 2007 to 2009...
August 2013: Injury
Elida Hysa
OBJECTIVE: The aim of this study was to assess the incidence and the effectiveness of treatment of fat embolism in patients with hip and long bone fractures (femur and tibia) in Albania. METHODS: 229 patients (68% men) with combined hip and long bone fractures (femur and tibia) hospitalized at the Orthopedics-Traumatology Services of the University Center "Mother Teresa" during 2004-2006 were included in the study. Patients were classified into three groups based on astrupogram data: PaO2<60mmHg, 65mmHg<PaO2<75mmHg, and PaO2>75mmHg...
2012: Materia Socio-medica
Sebastian Harder, Jochen Graff
BACKGROUND: Novel oral anticoagulants are approved in several indications: rivaroxaban, apixaban, and dabigatran for the prevention of venous thromboembolism after elective hip or knee replacement surgery, and edoxaban for hip or knee replacement surgery and hip fracture surgery (in Japan only); rivaroxaban for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE; and rivaroxaban, apixaban, and dabigatran for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation...
September 2013: European Journal of Clinical Pharmacology
Mark A Vitale, Corinne Vanbeek, John H Spivack, Bin Cheng, Jeffrey A Geller
PURPOSE: Patients with acute hip fractures who are on maintenance warfarin for anticoagulation present a significant challenge and their management remains controversial. The purpose of this study was to assess thromboembolic and systemic complications associated with pharmacological reversal of warfarin-associated coagulopathy in a population of geriatric patients with hip fractures. METHODS: This retrospective cohort study identified patients with operative hip fractures on oral warfarin therapy who had an international normalized ratio (INR) >1...
July 2011: Geriatric Orthopaedic Surgery & Rehabilitation
Diana M Sobieraj, Craig I Coleman, Vanita Tongbram, Wendy Chen, Jennifer Colby, Soyon Lee, Jeffrey Kluger, Sagar Makanji, Ajibade Ashaye, C Michael White
STUDY OBJECTIVE: To evaluate the comparative efficacy and safety of combination pharmacologic and mechanical venous thromboembolism (VTE) prophylaxis versus either method alone in major orthopedic surgery. DESIGN: Systematic review with meta-analysis of six randomized controlled trials. PATIENTS: Patients undergoing total hip replacement, total knee replacement, or hip fracture surgery who received VTE prophylaxis. MEASUREMENTS AND MAIN RESULTS: We conducted a systematic literature search of the MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus databases (January 1980-July 2011) to identify trials that directly compared pharmacologic plus mechanical VTE prophylaxis to either strategy alone, evaluated United States Food and Drug Administration-approved agents, and reported rates of mortality, VTE, bleeding, and other adverse effects...
March 2013: Pharmacotherapy
Charles W Francis
Venous thromboembolism (VTE) is a serious risk after major orthopedic surgery (MOS) including total knee replacement, total hip replacement and hip fracture surgery. This risk can be reduced with several pharmacologic and mechanical prophylactic approaches, and the choice among them depends on their ability to reduce VTE with an acceptable increase in adverse events, especially major bleeding complications. Improvements in medical and surgical care have led to a progressive decrease in the risk of VTE after MOS with an estimated baseline risk with contemporary practice of approximately 4...
April 2013: Journal of Thrombosis and Thrombolysis
N C Liew, Y H Chang, G Choi, P H Chu, X Gao, H Gibbs, C O Ho, H Ibrahim, T K Kim, B Kritpracha, L H Lee, L Lee, W Y Lee, Y J Li, A N Nicolaides, D Oh, D Pratama, N Ramakrishnan, P A Robless, G Villarama-Alemany, R Wong
Venous thromboembolism (VTE) prophylaxis is under-utilized in Asia because of the misconception that its incidence is lower in Asians as compared to the Caucasians. The available data on VTE in Asia is limited due to the lack of well-designed multicenter randomized controlled trials as well as non-standardized research designs, making data comparison difficult. Emerging data indicates that the VTE incidence is not low in Asia, and is comparable to that reported in the Western literature in some instances. There is also a trend towards increasing incidence of VTE, as demonstrated by a number of hospital-based studies in Asia...
December 2012: International Angiology: a Journal of the International Union of Angiology
F Bonnaire, C Straßberger, M Kieb, P Bula
Proximal femoral fractures in the elderly are still increasing and are almost always associated with osteoporosis. Especially the over 80-year-olds are increasing and at risk in this respect. In the treatment of these patients new knowledge has been achieved over the last years. An interdisciplinary, multimodal approach with early involvement of internists, geriatricians, anesthetists, osteologists, social workers, care facilities and outpatient trauma and orthopedic surgeons seems to generate a better outcome with fewer complications...
October 2012: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Kenzo Uchida, Kohei Negoro, Yasuo Kokubo, Takafumi Yayama, Tsuyoshi Miyazaki, Hideaki Nakajima, Ai Yoshida, Hisatoshi Baba
INTRODUCTION: Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. CASE PRESENTATION: We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1...
2012: Journal of Medical Case Reports
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