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German Congress of Orthopedic and Trauma Surgery (DKOU 2018)

23.10. - 26.10.2018, Berlin

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Impact of oral anticoagulation on proximal femur fractures treated within 24 hours – a retrospective chart review

Meeting Abstract

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  • presenting/speaker Konrad Schütze - Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinik Ulm, Ulm, Germany
  • Bertram Hummel - Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinik Ulm, Ulm, Germany
  • Alexander Eickhoff - Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinik Ulm, Ulm, Germany
  • Florian Gebhard - Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinik Ulm, Ulm, Germany
  • Peter Richter - Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinik Ulm, Ulm, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocST40-827

doi: 10.3205/18dkou253, urn:nbn:de:0183-18dkou2531

Published: November 6, 2018

© 2018 Schütze et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives: About one third of all patients with proximal femur fractures take oral anticoagulation like aspirin (ASS), direct platelet aggregation inhibitors like Clopidogrel and Ticagrelor (PAI), vitamin-K-antagonists like Warfarin (VKA) and direct oral anticoagulants like Rivaroxaban and Apixaban (DOAC). The management and timing of the surgery is a rising challenge in orthopedic trauma. Our objective was to determine the effect of oral anticoagulation on patients with proximal femur fractures, which received a proximal femur nail antirotation (PFNA) within 24 hours after trauma.

Methods: A retrospective chart review of 338 patients (mean age 80 +/- 13 years; 230 women and 108 men) with a sub- or intertrochanteric fractures between January 2012 and December 2017 was performed. Solely patients without or with only one type of oral anticoagulation were included. There were 90 patients undergoing treatment with ASS, 33 on PAI, 54 on DOAC and 28 on VKA. All patients taking VKA received high dose Vitamin K or coagulation factors to normalize INR prior to surgery. Primary outcome measures were the transfusion rate and pre- and postoperative hemoglobin (Hb) difference. Secondary outcome measures were mortality and complications like infection, hematoma and acute cardiovascular events.

Results and conclusion: Patients undergoing treatment with DOAC had a 3.8-fold increased risk for intraoperative blood transfusion. The risk for blood transfusion for patients taking ASS, PAI or VKA did no differ from the control group. Patients without an intraoperative blood transfusion on oral anticoagulation showed no increase in the pre- and postoperative Hb-difference compared with controls. Anticoagulation showed no significant effect on complication rates and mortality in patients operated within the first 24 hours.

There was no increase in mortality or rate of complications in patients treated with oral anticoagulation when operated within the first 24 hours. Treatment with DOAC showed a higher risk for the need of a blood transfusion intraoperatively. There was no Hb-difference between patients with oral anticoagulation and the controls.