gms | German Medical Science

128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

The impact of medicamentous anticoagulation on point of surgical care, operation time, necessity of transfusion and complication rate in geriatric patients with proximal femoral fracture

Meeting Abstract

  • Benjamin Bücking - Universitätsklinikum Giessen und Marburg, Standort Marburg, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Marburg
  • Johannes Stuewer - Universitätsklinikum Giessen und Marburg, Standort Marburg, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Marburg
  • Lutz Waschnick - Universitätsklinikum Giessen und Marburg, Standort Marburg, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Marburg
  • Steffen Ruchholtz - Universitätsklinikum Giessen und Marburg, Standort Marburg, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Marburg

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch695

DOI: 10.3205/11dgch695, URN: urn:nbn:de:0183-11dgch6951

Published: May 20, 2011

© 2011 Bücking et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: Hip fractures represent typical fractures of the elderly. According to actual literature these fractures are often associated with preexisting morbidity and extensive medication in particular concerning medicamentous anticoagulation. It was objective of the present study to evaluate our standard operation procedure (SOP) concerning anticoagulation in patients with proximal femoral fracture. Patients on anticoagulation with cumarine derivates were applicated vitamine K. Surgical care was not performed until the Quick value was at least more than 50%. Acetylsalicylid acid and clopidogrel did not have any impact on our therapeutic strategy.

Materials and methods: Patients with proximal femoral fracture and minimum age of 60 years were included from april 2009 until april 2010. We exclude patients with polytrauma and with pathological fractures. Data concerning age, gender and medicamentous anticoagulation (acetylsalicylic acid, cumarine derivates (e.g. Marcumar), clopidogrel) were collected on admission. Furthermore we recorded data concerning point of surgical care, operating time, the amount of transfusion and postoperative bleeding complication. Ethics approval was obtained and each of the patients gives his/her consent.

Results: 157 patients were included between april 2009 and april 2010 (118 female, 39 male). The mean age was 81 years. Patients on medication with acetylsalicylic acid (n=67(43%)) demonstrated significant increase in operation time, transfusion rate and incidence of postoperative hematomas. 32 (20%) patients were on medication with marcumar. Medication with marcumar leads to a delayed time for operation. Clopidogrel intake was very rare (n=5(3%)).

Conclusion: Our study demonstrated a widespread use of medicamentous anticoagulation concerning this patient sample. Patients on medication with acetylsalicylic might profit from a delay of surgical intervention. Patients might profit by a more aggressive antagonisation of Marcumar due to minimization of the interval to definitive surgical care. A more dedicated analysis under consideration of actual comorbidities and different operational methods is necessary. A risk-benefit analysis can be performed thereafter.