Gosch M, Jacobs M, Bail H, Grueninger S, Wicklein S
Department for Geriatric Medicine, Paracelsus Private Medical University, General Hospital Nuremberg, Prof. Ernst Nathan Strasse 1, 90419, Nuremberg, Germany.
Department for Orthopaedics and Traumatology, Paracelsus Private Medical University, General Hospital Nuremberg, Nuremberg, Germany.
Arch Orthop Trauma Surg. 2021 Apr;141(4):637-643. doi: 10.1007/s00402-020-03547-8. Epub 2020 Jul 24.
Older hip fracture patients are still challenging in daily clinical practice. Due to the high prevalence of osteoporosis and atrial fibrillation in this age group, the number of fragility fracture patients under oral anticoagulation (OAC) increases. The outcome is still disappointing, short- and long-term mortality and morbidity is high. The impact of pre-existing OAC is not yet clear, especially regarding new OAC drugs like Factor Xa inhibitors (FXa). The purpose of our study was to compare the short-term outcome of older hip fracture patients, without OAC (controls), on Vitamin K antagonists (VKA) and on FXa.
The study is a retrospective case-control study including patients older than 70 years who sustained hip fractures caused by an inadequate trauma and treated at a level 1 trauma center from February 2017 to June 2018. Patient's information was taken from patient's charts. 102 cases were analysed, 61 controls, 41 on OAC (15 on VKA and 26 on FXa). As outcome parameter we defined mortality, perioperative complications, bleeding, need of blood supplements, delay of surgery, length of stay, and a combined outcome parameter (mortality, myocardial infarction, stroke, thromboembolic events, blood preservations, re-vision surgery, major bleeding and decline of hemoglobin).
Eight patients died during hospital stay, in-hospital mortality was 7.8%. The highest mortality rate was found in patients on VKA (20%), compared to patients on FXa (3.8%) and controls (6.6%). However, mortality rate did not differ significantly within the groups. The combined endpoint was significantly more frequently seen in patients on OAC compared to controls (p = 0.006). No difference was observed between patients on VKA or FXa. Mean time to surgery and LOS was significantly longer in patients on OAC compared to controls. No significant differences were seen between VKA and FXa.
In our study OAC was significantly associated with worse outcome compared to controls. Marginal differences were observed between patients on FXa or VKA. Further studies involving a higher number of patients are necessary to confirm our results. At that time, some our results have to interpreted carefully and need confirmation.
在日常临床实践中，老年髋部骨折患者仍然具有挑战性。由于该年龄组骨质疏松症和心房颤动的高患病率，接受口服抗凝治疗（OAC）的脆性骨折患者数量增加。但其结果仍然令人失望，短期和长期死亡率及发病率都很高。既往OAC的影响尚不清楚，尤其是对于像Xa因子抑制剂（FXa）这样的新型OAC药物。我们研究的目的是比较未接受OAC（对照组）、接受维生素K拮抗剂（VKA）和接受FXa治疗的老年髋部骨折患者的短期结局。
本研究是一项回顾性病例对照研究，纳入了2017年2月至2018年6月在一级创伤中心接受治疗的、年龄大于70岁且因低能量创伤导致髋部骨折的患者。患者信息取自病历。共分析了102例病例，其中61例为对照组，41例接受OAC治疗（15例接受VKA治疗，26例接受FXa治疗）。作为结局参数，我们定义了死亡率、围手术期并发症、出血情况、输血需求、手术延迟、住院时间以及一个综合结局参数（死亡率、心肌梗死、中风、血栓栓塞事件、输血、翻修手术、大出血和血红蛋白下降）。
8例患者在住院期间死亡，住院死亡率为7.8%。VKA治疗组患者的死亡率最高（20%），而FXa治疗组患者的死亡率为3.8%，对照组为6.6%。然而，各组之间的死亡率差异无统计学意义。与对照组相比，OAC治疗组患者更频繁出现综合终点事件（p = 0.006）。VKA治疗组和FXa治疗组患者之间未观察到差异。与对照组相比，OAC治疗组患者的平均手术时间和住院时间显著更长。VKA治疗组和FXa治疗组之间未观察到显著差异。
在我们的研究中，与对照组相比，OAC与更差的结局显著相关。FXa治疗组和VKA治疗组患者之间观察到微小差异。需要开展更多患者参与的进一步研究来证实我们的结果。届时，我们的一些结果必须谨慎解读并需要进一步证实。
