gms | German Medical Science

Objectives: According to current guidelines surgical treatment of hip fractures has to be initiated within 48h. This often poses a challenge, as the main focus group are elderly patients with numerous comorbities and frequently on medical anticoagulation. Despite the existence of Prothrombin complex concentrates (PCC) for acute warfarin reversal, they are rarely used, mostly only in patients with urgent indications for surgery. The aim of this study was to assess the complication rate in hip fracture patients on medical anticoagulation (especially warfarin) with different types of antagonisation.

Methods: We retrospectively evaluated the data of all hip fracture patients treated at the Department of Trauma Surgery of the Medical University of XXX in 2011. In addition to the medical anticoagulation, we evaluated the time to surgery, length of stay, several blood values over multiple time points and the mobilization as well as systemic and local complications.

Results and Conclusion: Out of 534 patients included in the study, 210 (39.3%) were on medical anticoagulation. Patients who received warfarin reversal with vitamin K, had the longest time to surgery (3.7 days) as well as the longest length of stay (19.5 days) and the highest CRP levels at all times, while patients who received warfarin reversal with Beriplex had the shortest time to surgery (0.1) and the shortest length of stay (11.3 days) as well as the lowest CRP values. Furthermore, with 14.6%, patients who received warfarin reversal with vitamin K had the highest rate of respiratory infections and with 9.8% the highest rate of mortality, whilst patients on medical anticoagulation with other drugs with 8.0% had the highest proportion of wound infections.

In summary, warfarin reversal with Beriplex appears to be superior to warfarin reversal with vitamin K in regard of postoperative infections and the mortality rate. An analysis of a bigger cohort over a longer period of time should be conducted.