Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study
Introduction Geriatric hip fracture patients are characterized by frailty due to multiple comorbidities, such as cardiovascular disease, in which the use of antithrombotics is frequent. The aim of this study is to assess the effect of antithrombotics on perioperative care and patient outcomes after...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-08-01
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| Series: | Geriatric Orthopaedic Surgery & Rehabilitation |
| Online Access: | https://doi.org/10.1177/21514593211037755 |
| _version_ | 1818357492707491840 |
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| author | Veronique A. J. I. M. van Rijckevorsel MD Gert R. Roukema MD Taco M. A. L. Klem MD, PhD Tjallingius M. Kuijper MD, PhD Louis de Jong MD |
| author_facet | Veronique A. J. I. M. van Rijckevorsel MD Gert R. Roukema MD Taco M. A. L. Klem MD, PhD Tjallingius M. Kuijper MD, PhD Louis de Jong MD |
| author_sort | Veronique A. J. I. M. van Rijckevorsel MD |
| collection | DOAJ |
| description | Introduction Geriatric hip fracture patients are characterized by frailty due to multiple comorbidities, such as cardiovascular disease, in which the use of antithrombotics is frequent. The aim of this study is to assess the effect of antithrombotics on perioperative care and patient outcomes after hip hemiarthroplasty following current guidelines. Materials and Methods This observational cohort study included all consecutively admitted patients with a femoral neck fracture requiring hip hemiarthroplasty between January 1 st 2010, and May 16 th 2016, in two level II trauma teaching hospitals. Patients with multiple trauma injuries were excluded. Results In total, n = 907 patients (68% female (n = 615), median age 84 years) were included of which n = 142 used a vitamin K antagonist (VKA) and n = 213 used antiplatelet (AP) therapy. Both were associated with more packed cell supplementation (.4 ± 1.1 units and .3 ± .8 units vs .2 ± .6 units, P < .001 and P = .03, respectively). VKA was associated with more hematomas compared no antithrombotics (23% vs 11%, P = .001). VKA had a longer time to surgery compared to no antithrombotics and AP (24 hours vs 19 and 20 hours, P < .001 and P < .001, respectively) and longer admission duration (9 days vs 7 days P < .001. There were no differences in 30 day mortality nor in 1-year mortality rates. Discussion All modifiable causes for deep SSI, such as hematomas, should be prevented in acute hip fracture surgery. Since antithrombotics are associated with hematomas, an optimal handling in perioperative setting is necessary. Conclusion VKA was associated with longer time to surgery, more hematomas, and longer admission duration. VKA and AP were associated with more packed cell supplementation. |
| first_indexed | 2024-12-13T20:13:58Z |
| format | Article |
| id | doaj.art-969bcc57f1ef48519bf12c3837689dc6 |
| institution | Directory Open Access Journal |
| issn | 2151-4593 |
| language | English |
| last_indexed | 2024-12-13T20:13:58Z |
| publishDate | 2021-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Geriatric Orthopaedic Surgery & Rehabilitation |
| spelling | doaj.art-969bcc57f1ef48519bf12c3837689dc62022-12-21T23:32:51ZengSAGE PublishingGeriatric Orthopaedic Surgery & Rehabilitation2151-45932021-08-011210.1177/21514593211037755Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort StudyVeronique A. J. I. M. van Rijckevorsel MDGert R. Roukema MDTaco M. A. L. Klem MD, PhDTjallingius M. Kuijper MD, PhDLouis de Jong MDIntroduction Geriatric hip fracture patients are characterized by frailty due to multiple comorbidities, such as cardiovascular disease, in which the use of antithrombotics is frequent. The aim of this study is to assess the effect of antithrombotics on perioperative care and patient outcomes after hip hemiarthroplasty following current guidelines. Materials and Methods This observational cohort study included all consecutively admitted patients with a femoral neck fracture requiring hip hemiarthroplasty between January 1 st 2010, and May 16 th 2016, in two level II trauma teaching hospitals. Patients with multiple trauma injuries were excluded. Results In total, n = 907 patients (68% female (n = 615), median age 84 years) were included of which n = 142 used a vitamin K antagonist (VKA) and n = 213 used antiplatelet (AP) therapy. Both were associated with more packed cell supplementation (.4 ± 1.1 units and .3 ± .8 units vs .2 ± .6 units, P < .001 and P = .03, respectively). VKA was associated with more hematomas compared no antithrombotics (23% vs 11%, P = .001). VKA had a longer time to surgery compared to no antithrombotics and AP (24 hours vs 19 and 20 hours, P < .001 and P < .001, respectively) and longer admission duration (9 days vs 7 days P < .001. There were no differences in 30 day mortality nor in 1-year mortality rates. Discussion All modifiable causes for deep SSI, such as hematomas, should be prevented in acute hip fracture surgery. Since antithrombotics are associated with hematomas, an optimal handling in perioperative setting is necessary. Conclusion VKA was associated with longer time to surgery, more hematomas, and longer admission duration. VKA and AP were associated with more packed cell supplementation.https://doi.org/10.1177/21514593211037755 |
| spellingShingle | Veronique A. J. I. M. van Rijckevorsel MD Gert R. Roukema MD Taco M. A. L. Klem MD, PhD Tjallingius M. Kuijper MD, PhD Louis de Jong MD Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study Geriatric Orthopaedic Surgery & Rehabilitation |
| title | Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study |
| title_full | Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study |
| title_fullStr | Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study |
| title_full_unstemmed | Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study |
| title_short | Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study |
| title_sort | antithrombotics in patients with a femoral neck fracture evaluating daily practice in an observational cohort study |
| url | https://doi.org/10.1177/21514593211037755 |
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