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Tytuł:
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Association of Reversal of Anticoagulation Preoperatively on 30-Day Mortality and Outcomes for Hip Fracture Surgery.
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Autorzy:
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Yoo MS; Department of Hospital Medicine, Kaiser Permanente, Santa Rosa, Calif. Electronic address: .
Zhu S; Division of Research, Kaiser Permanente, Oakland, Calif.
Jiang SF; Division of Research, Kaiser Permanente, Oakland, Calif.
Hammer HL; Department of Hospital Medicine, Kaiser Permanente, Santa Rosa, Calif.
McBride WJ; Department of Hospital Medicine, Kaiser Permanente, Santa Rosa, Calif.
McCarthy CM; Department of Hospital Medicine, Kaiser Permanente, Santa Rosa, Calif.
Green CE; Department of Family Medicine, Sutter Santa Rosa Regional Hospital, Santa Rosa, Calif.
Ananias MP; Department of Hospital Medicine, Kaiser Permanente, Santa Rosa, Calif.
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Źródło:
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The American journal of medicine [Am J Med] 2020 Aug; Vol. 133 (8), pp. 969-975.e2. Date of Electronic Publication: 2020 Jan 30.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: New York, NY : Excerpta Medica
Original Publication: New York, Donnelly.
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MeSH Terms:
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Anticoagulants/*adverse effects
Antifibrinolytic Agents/*therapeutic use
Blood Coagulation Factors/*therapeutic use
Blood Loss, Surgical/*prevention & control
Hip Fractures/*surgery
Postoperative Hemorrhage/*prevention & control
Preoperative Care/*methods
Black or African American ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal, Humanized/therapeutic use ; Arthroplasty, Replacement, Hip ; Asian ; Blood Transfusion ; Cohort Studies ; Delirium/epidemiology ; Factor Xa Inhibitors/adverse effects ; Female ; Fracture Fixation, Internal ; Hispanic or Latino ; Humans ; International Normalized Ratio ; Length of Stay ; Male ; Mortality ; Orthopedic Procedures ; Plasma ; Postoperative Complications ; Postoperative Hemorrhage/chemically induced ; Proportional Hazards Models ; Retrospective Studies ; Sex Factors ; Vitamin K/therapeutic use ; Warfarin/adverse effects ; White People
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Contributed Indexing:
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Keywords: Anticoagulation; Hip fracture; Outcomes; Perioperative medicine; Reversal agents
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Substance Nomenclature:
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0 (Antibodies, Monoclonal, Humanized)
0 (Anticoagulants)
0 (Antifibrinolytic Agents)
0 (Blood Coagulation Factors)
0 (Factor Xa Inhibitors)
12001-79-5 (Vitamin K)
37224-63-8 (prothrombin complex concentrates)
5Q7ZVV76EI (Warfarin)
97RWB5S1U6 (idarucizumab)
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Entry Date(s):
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Date Created: 20200203 Date Completed: 20200921 Latest Revision: 20221207
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Update Code:
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20240105
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DOI:
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10.1016/j.amjmed.2020.01.002
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PMID:
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32007455
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Background: Hip fracture is common in the elderly, many of whom are on anticoagulation. However, data are limited on outcomes with anticoagulation reversal in patients undergoing hip fracture surgery.
Methods: Adults ≥60 years old on oral anticoagulation who underwent hip fracture surgery at 21 hospitals in Northern California from 2006 to 2016 were identified through electronic databases. Outcomes were compared among patients treated and untreated with anticoagulation reversal preoperatively.
Results: Of 1984 patients on oral anticoagulation who underwent hip fracture surgery, 1943 (97.9%) were on warfarin and 41 (2.1%) were on direct oral anticoagulants. Reversal agents were administered to 1635 (82.4%). Compared to a watch-and-wait strategy, patients receiving reversal agents were more likely to be white, male, comorbid, and with higher admission and preoperative international normalized ratios (P <0.001 for all comparisons). No difference for 30-day mortality was detected between reversal vs non-reversal (7.8% vs 6.0%, respectively; hazard ratio [HR], 1.30 [95% confidence interval (CI), 0.82-2.07]). For secondary outcomes, reversal was associated with higher risk of delirium (8.6% vs 4.9%, risk ratio [RR], 1.77 [95% CI, 1.08-2.89]) and increased mean length of stay (6.4 vs 5.8 days, P <0.05). After adjustment, associations were no longer significant for delirium (RR 1.60, 95% CI, 0.97-2.65) or length of stay (mean difference 0.08, 95% CI, -0.55-0.71). No associations were detected between reversal and other secondary outcomes.
Conclusion: No significant associations were found between reversal agents and 30-day mortality or other outcomes in patients on oral anticoagulation who underwent hip fracture surgery. Further investigation is needed.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
