Anticoagulation Management in Individuals with Hip Fracture. Issue 1 (2nd January 2014)

• Record Type: Journal Article
• Authors: Gleason, Lauren J.; Mendelson, Daniel A.; Kates, Stephen L.; Friedman, Susan M.
• Is Part Of: Journal of the American Geriatrics Society. Volume 62:Issue 1(2014:Jan.)
• Page Start: 159
• Page End: 164
• Publication Date: 2014-01-02
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12591
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12591-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12591-sec-0001" sec-type="section"> <title>Objectives</title> <p>To determine the interventions taken to lower international normalized ratio (INR) in individuals with hip fracture using warfarin before admission for hip fracture surgery in a geriatric fracture center (GFC) and compare outcomes with those of individuals not taking warfarin.</p> </sec> <sec id="jgs12591-sec-0002" sec-type="section"> <title>Design</title> <p>Cohort study using retrospective chart review.</p> </sec> <sec id="jgs12591-sec-0003" sec-type="section"> <title>Setting</title> <p>University‐affiliated community teaching hospital.</p> </sec> <sec id="jgs12591-sec-0004" sec-type="section"> <title>Participants</title> <p>Individuals aged 60 and older admitted to a GFC for surgical repair of a nonpathological, nonperiprosthetic hip fracture between April 2006 and April 2012.</p> </sec> <sec id="jgs12591-sec-0005" sec-type="section"> <title>Measurements</title> <p>Descriptive data collected from a quality improvement registry with additional information for individuals taking warfarin obtained from chart review.</p> </sec> <sec id="jgs12591-sec-0006" sec-type="section"> <title>Results</title> <p>Of the 1, 080 individuals included in the analysis, 84 (7.8%) were taking warfarin on admission. Participants using warfarin had a higher average Charlson Comorbidity Index (3.8 vs 3.1, <italic>P </italic><<italic> </italic>.001). Atrial fibrillation was the most common indication for anticoagulation (83.3%). Average INR before surgery was 1.7 (range 1.2–3.6). Vitamin K, fresh frozen plasma, or both were given to 100% of those taking warfarin with an admission INR of 2.0 or greater. There was a trend toward longer time to surgery in those taking warfarin than in those not taking warfarin (28.9 vs 21.7 hours, <italic>P </italic>=<italic> </italic>.05). Length of stay was longer for those taking warfarin than those not taking warfarin (4.8 vs 4.2 days, <italic>P </italic>=<italic> </italic>.04). Neither time to surgery nor length of stay were significantly different after adjustment for baseline comorbidity. Participants taking warfarin were not found to have any significant differences in thromboembolic event rates, bleeding complications rates, mortality, or 30‐day readmission after surgery than those not taking warfarin on admission.</p> </sec> <sec id="jgs12591-sec-0007" sec-type="section"> <title>Conclusion</title> <p>Active management in a GFC model to reverse anticoagulation before surgery may facilitate earlier surgery without increasing observed complications.</p> </sec> </abstract>