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Semin Thromb Hemost 2019; 45(02): 164-170
DOI: 10.1055/s-0039-1678718
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Patients Taking Oral Anticoagulants Who Need Urgent Surgery for Hip Fracture

Elvira Grandone
1   Fondazione, “Casa Sollievo della Sofferenza,” S. Giovanni Rotondo, Foggia, Italy
2   Ob/Gyn Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
,
Angelo Ostuni
3   UOC Medicina Trasfusionale, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
,
Giovanni L. Tiscia
1   Fondazione, “Casa Sollievo della Sofferenza,” S. Giovanni Rotondo, Foggia, Italy
,
Francesco Marongiu
4   Dipartimento di Scienze Mediche Internistiche, University of Cagliari, Cagliari, Italy
,
Doris Barcellona
4   Dipartimento di Scienze Mediche Internistiche, University of Cagliari, Cagliari, Italy
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
11. Februar 2019 (online)

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Abstract

The number of hip fractures in anticoagulated patients is predicted to increase, due to people living longer. However, evidence regarding urgent perioperative management of elderly patients with hip fracture who take oral anticoagulants (vitamin K antagonists or direct oral anticoagulants) is scarce. In this article, the authors present a narrative review of the evidence to date supporting the urgent management of hip fracture in anticoagulated elderly patients. They discuss the complexity of managing the high risk of procedure-related bleeding and, at the same time, the high risk of thromboembolism. The role of a bridging procedure and the best strategy of anticoagulation reversal are also reviewed. Further studies are required to improve the evidence in urgent surgery, especially in frail elderly patients.

Keywords

anticoagulants - hip fractures - venous thromboembolism - hemorrhage - aged - emergencies

Source of Support

No source of support was provided for this paper.


 

  • References

  • 1 Steinberg BA, Peterson ED, Kim S. , et al; Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Investigators and Patients. Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation 2015; 131 (05) 488-494
    CrossrefPubMedGoogle Scholar
  • 2 No authors cited. The National Hip Fracture Database. National Report, 2010. Available at: http://www.ccad.org.uk/nhfd.nsf/NHFD_National_Report_2010.pdf . Accessed August 3, 2016
    PubMedGoogle Scholar
  • 3 White SM, Griffiths R, Holloway J, Shannon A. Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network. Anaesthesia 2010; 65 (03) 243-248
    CrossrefPubMedGoogle Scholar
  • 4 Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C. ; IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012; 23 (09) 2239-2256
    CrossrefPubMedGoogle Scholar
  • 5 Spyropoulos AC, Al-Badri A, Sherwood MW, Douketis JD. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost 2016; 14 (05) 875-885
    CrossrefPubMedGoogle Scholar
  • 6 Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 2010; 39 (02) 203-209
    CrossrefPubMedGoogle Scholar
  • 7 Folbert EC, Hegeman JH, Gierveld R. , et al. Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment. Arch Orthop Trauma Surg 2017; 137 (04) 507-515
    CrossrefPubMedGoogle Scholar
  • 8 Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014; 43 (04) 464-471
    CrossrefPubMedGoogle Scholar
  • 9 American Academy of Orthopaedic Surgeons. Management of hip fracture in the elderly: evidence-based clinical practice guideline; 2014. Available at: www.aaos.org/Research/guidelines/HipFxGuideline.pdf . Accessed December 30, 2015
    PubMedGoogle Scholar
  • 10 National Institute for Health and Care Excellence (NICE). Hip Fracture: The Management of Hip Fracture in Adults. CG124. London, UK: NICE; 2011
    Google Scholar
  • 11 Falck-Ytter Y, Francis CW, Johanson NA. , et al. College of Chest Physicians. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e278S-325S
    CrossrefPubMedGoogle Scholar
  • 12 Abelseth G, Buckley RE, Pineo GE, Hull R, Rose MS. Incidence of deep-vein thrombosis in patients with fractures of the lower extremity distal to the hip. J Orthop Trauma 1996; 10 (04) 230-235
    CrossrefPubMedGoogle Scholar
  • 13 McMurtry MS, Cairns JA. Anticoagulation in elderly patients with chronic kidney disease: how safe is it?. Can J Cardiol 2016; 32 (08) 941.e3-941.e5
    CrossrefPubMedGoogle Scholar
  • 14 Harel Z, Mamdani M, Juurlink DN. , et al. Novel oral anticoagulants and the risk of major hemorrhage in elderly patients with chronic kidney disease: a nested case-control study. Can J Cardiol 2016; 32 (08) 986.e17-986.e22
    CrossrefPubMedGoogle Scholar
  • 15 Handoll HHG, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. Cochrane Database Syst Rev 2002; (04) CD000305
    PubMedGoogle Scholar
  • 16 Fisher W. Managing hip fracture and lower limb surgery in the emergency setting: potential role of non-vitamin K antagonist oral anticoagulants. J Trauma Acute Care Surg 2017; 82 (06) 1112-1121
    CrossrefPubMedGoogle Scholar
  • 17 Lassen MR, Haas S, Kreutz R, Mantovani LG, Holberg G, Turpie AG. Rivaroxaban for thromboprophylaxis after fracture-related orthopedic surgery in routine clinical practice. Clin Appl Thromb Hemost 2016; 22 (02) 138-146
    CrossrefPubMedGoogle Scholar
  • 18 Fuji T, Fujita S, Kawai Y. , et al. Safety and efficacy of edoxaban in patients undergoing hip fracture surgery. Thromb Res 2014; 133 (06) 1016-1022
    CrossrefPubMedGoogle Scholar
  • 19 Long A, Zhang L, Zhang Y. , et al. Efficacy and safety of rivaroxaban versus low-molecular-weight heparin therapy in patients with lower limb fractures. J Thromb Thrombolysis 2014; 38 (03) 299-305
    CrossrefPubMedGoogle Scholar
  • 20 Conteduca F, Massai F, Iorio R, Zanzotto E, Luzon D, Ferretti A. Blood loss in computer-assisted mobile bearing total knee arthroplasty. A comparison of computer-assisted surgery with a conventional technique. Int Orthop 2009; 33 (06) 1609-1613
    CrossrefPubMedGoogle Scholar
  • 21 Zhang P, He J, Fang Y, Chen P, Liang Y, Wang J. Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: a meta-analysis. Medicine (Baltimore) 2017; 96 (21) e6940
    PubMedGoogle Scholar
  • 22 Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood 2012; 120 (15) 2954-2962
    CrossrefPubMedGoogle Scholar
  • 23 Venker BT, Ganti BR, Lin H, Lee ED, Nunley RM, Gage BF. Safety and efficacy of new anticoagulants for the prevention of venous thromboembolism after hip and knee arthroplasty: a meta-analysis. J Arthroplasty 2017; 32 (02) 645-652
    CrossrefPubMedGoogle Scholar
  • 24 Riva N, Dentali F, Permunian ET, Ageno W. Major bleeding and case fatality rate with the direct oral anticoagulants in orthopedic surgery: a systematic review and meta-analysis. Semin Thromb Hemost 2016; 42 (01) 42-54
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 25 Sridharan K, Sivaramakrishnan G. Tranexamic acid in total knee arthroplasty: mixed treatment comparisons and recursive cumulative meta-analysis of randomized, controlled trials and cohort studies. Basic Clin Pharmacol Toxicol 2018; 122 (01) 111-119
    CrossrefPubMedGoogle Scholar
  • 26 Oktay E. Will NOACs become the new standard of care in anticoagulation therapy?. Int J Cardiovasc Acad 2015 DOI: 10.1016/j.ijcac.2015.06.007
    PubMedGoogle Scholar
  • 27 Food and Drug Administration. FDA NEWS RELEASE. FDA approves Kcentra for the urgent reversal of anticoagulation in adults with major bleeding. Available at: http://wayback.archive-it.org/7993/20170112213533/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm350026.htm . Accessed April 29, 2013
    PubMedGoogle Scholar
  • 28 European Medicines Agency. Core SPC for human prothrombin complex products [CPMP/BPWG/3735/02]. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003518.pdf . Accessed January 12, 2012
    PubMedGoogle Scholar
  • 29 Chai-Adisaksopha C, Hillis C, Siegal DM. , et al. Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal. A systematic review and meta-analysis. Thromb Haemost 2016; 116 (05) 879-890
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 30 Fariborz Farsad B, Golpira R, Najafi H. , et al. Comparison between prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) for the urgent reversal of warfarin in patients with mechanical heart valves in a tertiary care cardiac center. Iran J Pharm Res 2015; 14 (03) 877-885
    PubMedGoogle Scholar
  • 31 Demeyere R, Gillardin S, Arnout J, Strengers PF. Comparison of fresh frozen plasma and prothrombin complex concentrate for the reversal of oral anticoagulants in patients undergoing cardiopulmonary bypass surgery: a randomized study. Vox Sang 2010; 99 (03) 251-260
    CrossrefPubMedGoogle Scholar
  • 32 Ortmann E, Besser MW, Sharples LD. , et al. An exploratory cohort study comparing prothrombin complex concentrate and fresh frozen plasma for the treatment of coagulopathy after complex cardiac surgery. Anesth Analg 2015; 121 (01) 26-33
    CrossrefPubMedGoogle Scholar
  • 33 Al-Rashid M, Parker MJ. Anticoagulation management in hip fracture patients on warfarin. Injury 2005; 36 (11) 1311-1315
    CrossrefPubMedGoogle Scholar
  • 34 Tharmarajah P, Pusey J, Keeling D, Willett K. Efficacy of warfarin reversal in orthopedic trauma surgery patients. J Orthop Trauma 2007; 21 (01) 26-30
    CrossrefPubMedGoogle Scholar
  • 35 Bhatia M, Talawadekar G, Parihar S, Smith A. An audit of the role of vitamin K in the reversal of International Normalised Ratio (INR) in patients undergoing surgery for hip fracture. Ann R Coll Surg Engl 2010; 92 (06) 473-476
    CrossrefPubMedGoogle Scholar
  • 36 Forster R, Stewart M. Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev 2016; 3: CD004179
    PubMedGoogle Scholar
  • 37 Schulman S, Carrier M, Lee AY. , et al; Periop Dabigatran Study Group. Perioperative management of dabigatran: a prospective cohort study. Circulation 2015; 132 (03) 167-173
    CrossrefPubMedGoogle Scholar
  • 38 Kundu A, Sardar P, Chatterjee S, Aronow WS, Owan T, Ryan JJ. Minimizing the risk of bleeding with NOACs in the elderly. Drugs Aging 2016; 33 (07) 491-500
    CrossrefPubMedGoogle Scholar
  • 39 Wang Y, Bajorek B. New oral anticoagulants in practice: pharmacological and practical considerations. Am J Cardiovasc Drugs 2014; 14 (03) 175-189
    CrossrefPubMedGoogle Scholar
  • 40 Godier A, Dincq AS, Martin AC. , et al. Predictors of pre-procedural concentrations of direct oral anticoagulants: a prospective multicentre study. Eur Heart J 2017; 38 (31) 2431-2439
    CrossrefPubMedGoogle Scholar
  • 41 Pollack Jr CV, Reilly PA, van Ryn J. , et al. Idarucizumab for dabigatran reversal- full cohort analysis. N Engl J Med 2017; 377 (05) 431-441
    CrossrefPubMedGoogle Scholar
  • 42 Connolly SJ, Milling Jr TJ, Eikelboom JW. , et al; ANNEXA-4 Investigators. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med 2016; 375 (12) 1131-1141
    CrossrefPubMedGoogle Scholar
  • 43 Huisman MV, Fanikos J. Idarucizumab and factor Xa reversal agents: role in hospital guidelines and protocols. Am J Emerg Med 2016; 34 (11S): 46-51
    CrossrefPubMedGoogle Scholar
  • 44 Flaker GC, Theriot P, Binder LG, Dobesh PP, Cuker A, Doherty JU. Management of periprocedural anticoagulation: a survey of contemporary practice. J Am Coll Cardiol 2016; 68 (02) 217-226
    CrossrefPubMedGoogle Scholar
  • 45 Siegal D, Yudin J, Kaatz S, Douketis JD, Lim W, Spyropoulos AC. Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation 2012; 126 (13) 1630-1639
    CrossrefPubMedGoogle Scholar
  • 46 Douketis JD, Spyropoulos AC, Spencer FA. , et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e326S-e350S . [Erratum in: Chest. 2012; 141: 1129]
    CrossrefPubMedGoogle Scholar
  • 47 Moores TS, Beaven A, Cattell AE, Baker C, Roberts PJ. Preoperative warfarin reversal for early hip fracture surgery. J Orthop Surg (Hong Kong) 2015; 23 (01) 33-36
    CrossrefPubMedGoogle Scholar
  • 48 Beyer-Westendorf J, Gelbricht V, Förster K. , et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J 2014; 35 (28) 1888-1896
    CrossrefPubMedGoogle Scholar