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Anticoagulant therapy in hip fracture

Yilun Tang, Kunzheng Wang, Zhibin Shi, Pei Yang, Xiaoqian Dang
The guidelines for the prevention of venous thromboembolism in orthopedic surgeries have reached a consensus on the postoperative conventional anticoagulation. However, the choice of anticoagulant drugs is yet controversial. The use of the drug rivaroxaban is expensive. Since the compliance of patients with low-molecular-weight heparin is considerably low, a cost-effective, efficacious and convenient anticoagulant program is essential. The present study investigated the efficacy, safety, patient compliance, and cost-effectiveness of low-molecular-weight heparin with sequential Rivaroxaban anticoagulant therapy in patients with a hip fracture, following internal fixation...
August 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Ioannis Ktistakis, Vasileios Giannoudis, Peter V Giannoudis
Hip fractures in the elderly population have become a 'disease' with increasing incidence.Most of the geriatric patients are affected by a number of comorbidities.Coagulopathies continue to be a special point of interest for the orthopaedic trauma surgeon, with the management of this high-risk group of patients a hot topic of debate among the orthopaedic community.While a universal consensus on how to manage thromboprophylaxis for this special cohort of patients has not been reached, multiple attempts to define a widely accepted protocol have been published...
August 2016: EFORT open reviews
N P Saragas, P N F Ferrao, B F Jacobson, E Saragas, A Strydom
BACKGROUND: Ten percent of patients with a deep-vein thrombosis (DVT) will develop a fatal pulmonary embolism (PE), often initially asymptomatic. The risks and benefits of pharmacological thromboprophylaxis are well documented in respect of total joint arthroplasty and hip fractures, but little is understood about the incidence of venous thromboembolism (VTE) or the potential risks and benefits of chemoprophylaxis in foot and ankle surgery. OBJECTIVE: To determine whether prophylactic chemoprophylaxis had any impact on the prevention of VTE in a cohort of foot and ankle surgical patients requiring the combination of below-knee cast immobilisation and non-weightbearing for ≥4 weeks...
March 29, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
J Sanz-Reig, J Salvador Marín, J Ferrández Martínez, D Orozco Beltrán, J F Martínez López
OBJECTIVE: To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. MATERIAL AND METHODS: A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay...
March 31, 2017: Revista Española de Cirugía Ortopédica y Traumatología
Guo Rong She, Jun Yuan Chen, Zi Qi Zhou, Zhen Gang Zha, Ning Liu
INTRODUCTION: Pyoderma gangrenosum is a rare inflammatory aseptic, ulcerative neutrophilic dermatosis which manifest as skin recurrent, painful ulcers. PRESENTATION OF CASE: A 65-year-old man with pyoderma gangrenosum underwent left total hip arthroplasty because of femoral neck fractures. Glucocorticoid, antibiotic, anticoagulant drug, etc. were given in perioperative period. Complication of pyoderma gangrenosum was prevented successfully in perioperative period...
December 9, 2016: International Journal of Surgery Case Reports
David Leibowitz, Chen Abitbol, Ronny Alcalai, Gurion Rivkin, Leonid Kandel
BACKGROUND: Hip fracture repair is commonly performed in elderly adults and is associated with high mortality. Limited data address the significance of perioperative atrial fibrillation (AF) and its subsequent treatment in emergent orthopedic surgery in the elderly. This study aimed to determine whether newly diagnosed AF among patients initially in sinus rhythm undergoing hip fracture repair is predictive of one-year mortality and whether medical therapy of AF attenuated this finding...
January 15, 2017: International Journal of Cardiology
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...
February 12, 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...
December 14, 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
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