Meinig Rick, Jarvis Stephanie, Orlando Alessandro, Nwafo Nnamdi, Banerjee Rahul, McNair Patrick, Woods Bradley, Harrison Paul, Nentwig Michelle, Kelly Michael, Smith Wade, Bar-Or David
Orthopedic Trauma, Penrose Hospital, 2222 North Nevada Ave, Colorado Springs, CO, 80907, USA.
Trauma Department, ION Research, 383 Corona St. #319, Denver, CO, 80218, USA.
J Clin Orthop Trauma. 2020 Feb;11(Suppl 1):S93-S99. doi: 10.1016/j.jcot.2019.10.004. Epub 2019 Oct 15.
Hip fracture surgery in geriatric patients on anticoagulants may increase the risk for blood loss. Anticoagulation reversal may lower these risks; however, data on blood loss and transfusions are limited. The study purpose was to compare outcomes between hip fracture patients 1) not on anticoagulants 2) whose anticoagulants were reversed, and 3) whose anticoagulants were not reversed.
This four-year retrospective cohort study at six Level 1 Trauma Centers enrolled geriatric patients (≥65) with isolated hip fractures. The primary outcome was total hospital blood loss (ml). Secondary outcomes: hospital length of stay (HLOS) and volume of packed red blood cells (pRBC) transfusions (ml). Statistical analyses included: Fisher's, chi-squared, Kruskal-Wallis, linear mixed-effect and logistic regression. Bonferroni adjusted alpha = 0.025.
Of the 459 patients, 189 (41%) were not on anticoagulants, 186 (41%) were reversed, and 84 (18%) were not reversed. The LS mean (SE) blood loss was 134 ml (12) for not reversed patients and 159 (17) for reversed patients; no significant difference compared to those not on anticoagulants [138 (12)], p-diff = 0.14 and 0.83, respectively. The LS mean (SE) HLOS was significantly longer for the reversed patients, 7.7 (0.4) days, when compared to those not on anticoagulants, 6.8 (0.4), p = 0.02, and when compared to those not reversed, 6.3 (0.6), p = 0.01. There was no significant difference in pRBC transfusions.
Not reversing anticoagulants for geriatric hip fractures was not associated with increased volume of blood loss or transfusions when compared to those reversed. Delayed surgery for anticoagulant reversal may be unnecessary and contributing to an increased HLOS.
老年抗凝患者进行髋部骨折手术可能会增加失血风险。抗凝逆转可能会降低这些风险；然而，关于失血和输血的数据有限。本研究的目的是比较髋部骨折患者的结局：1）未使用抗凝剂的患者；2）抗凝剂已逆转的患者；3）抗凝剂未逆转的患者。
这项在六个一级创伤中心进行的为期四年的回顾性队列研究纳入了患有孤立性髋部骨折的老年患者（≥65岁）。主要结局是住院期间的总失血量（毫升）。次要结局：住院时间（HLOS）和浓缩红细胞（pRBC）输血量（毫升）。统计分析包括：费舍尔检验、卡方检验、克鲁斯卡尔 - 沃利斯检验、线性混合效应和逻辑回归。经邦费罗尼校正的α = 0.025。
459例患者中，189例（41%）未使用抗凝剂，186例（41%）抗凝剂已逆转，84例（18%）抗凝剂未逆转。未逆转组患者的最小二乘均值（标准误）失血量为134毫升（12），逆转组为159毫升（17）；与未使用抗凝剂的患者相比[138毫升（12）]无显著差异，p值分别为0.14和0.83。与未使用抗凝剂的患者相比，逆转组患者的最小二乘均值（标准误）住院时间显著更长，为7.7天（0.4），未使用抗凝剂组为6.8天（0.4），p = 0.02，与未逆转组相比，未逆转组为6.3天（0.6），p = 0.01。pRBC输血方面无显著差异。
与抗凝剂已逆转的老年髋部骨折患者相比，不逆转抗凝剂与失血量或输血量增加无关。为进行抗凝逆转而延迟手术可能没有必要，且会导致住院时间延长。
