Managing Hip Fracture in Patients Taking Warfarin

Surgical Rounds®February 2014

Though warfarin is often used to prevent coagulation and treat existing blood clots, many questions arise when geriatric patients who take the anticoagulant fracture a hip.

Blood clotting after hip fracture is a topic of seemingly endless debate, since no guidelines exist to address every possible situation. Nevertheless, warfarin is often used to prevent coagulation and treat existing clots because it is available as a generic medication and has been around for years.

Still, many questions arise when geriatric patients taking warfarin fracture a hip. To address those concerns, a team of US researchers from several prestigious university-affiliated community teaching hospitals conducted a retrospective chart review, which was published in a recent issue of Aging and Surgery.

Using descriptive data from a quality improvement registry and supplementing it with information obtained from chart reviews conducted between April 2006 and April 2012, the researchers examined postoperative outcomes in 1,080 patients receiving warfarin. On admission, 7.8% of the patients had been taking warfarin. Their average preoperative international normalized ratio (INR) was 1.7, though most experts recommend achieving an INR ≤1.5 prior to surgery.

According to the authors, the patients who were taking warfarin on admission had a longer time to surgery and length of stay compared to those who were not taking warfarin, which was possibly related to the extra time needed to reverse INR. Nevertheless, postoperative thromboembolic events, bleeding complications, mortality, and 30-day readmission rates were similar regardless of warfarin status.

The surgeons observed in the study preoperatively managed patients taking warfarin with vitamin K, fresh frozen plasma, or both. Although most of the measures the researchers examined were similar between the 2 groups, those taking warfarin tended to have a higher incidence of death. However, the increased rates of comorbidities among patients taking warfarin may explain the difference in mortality, the authors said.

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