Fondazione, "Casa Sollievo della Sofferenza," S. Giovanni Rotondo, Foggia, Italy.
Ob/Gyn Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation.
Semin Thromb Hemost. 2019 Mar;45(2):164-170. doi: 10.1055/s-0039-1678718. Epub 2019 Feb 11.
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.
由于人们寿命的延长，预计接受抗凝治疗的髋部骨折患者数量将会增加。然而，有关接受口服抗凝药物（维生素 K 拮抗剂或直接口服抗凝剂）治疗的老年髋部骨折患者围手术期紧急管理的证据仍然有限。本文作者对迄今为止支持紧急管理接受抗凝治疗的老年髋部骨折患者的证据进行了叙述性综述。他们讨论了管理与手术相关的出血高风险以及同时存在的血栓栓塞高风险的复杂性。还回顾了桥接治疗的作用和最佳抗凝逆转策略。需要进一步的研究来提高紧急手术方面的证据质量，特别是对于体弱的老年患者。
