Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK.
Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK.
Injury. 2021 Jun;52(6):1473-1479. doi: 10.1016/j.injury.2020.12.036. Epub 2021 Jan 2.
Hip fractures are a large burden on the health care systems of developed nations. Patients usually have multiple co-morbidities and the pre-injury use of anticoagulants and anti-platelet medication is common.
This study used a single hospital hip fracture database to facilitate a retrospective analysis of the impact of anti-coagulation and anti-platelet therapy on mortality and complications after surgical management of hip fractures. There were 92 patients on warfarin, 69 on DOAC, 260 antiplatelet patients and 617 control patients.
Mortality rates at 30 days were 4.8% for the control group, 12.6% for the antiplatelet group, warfarin 7.0%, 9.5% for Direct Oral Anticoagulant (DOAC) group, p = 0.004. Mortality rates at 1 year were 22.4% for the control group, 32.3% for the antiplatelet group, 29.3% for the warfarin group and 29.0% for DOAC group (p=0.007). Amongst complications, significant differences were found in transfusion (DOAC) and wound ooze (warfarin) rates, but the study did not detect significant clinical consequences arising from these differences. A matched analysis for age, sex, and ASA was undertaken to look in more detail at mortality data. Some mortality differences remained between groups with anti-platelet medication associated with increased mortality, but the differences no longer appeared to be significant. Our data suggests that this is a non-causal association, which could be incorporated into predictive mortality risk scores such as the Nottingham hip fracture score.
We believe that pre-injury antiplatelet therapy is a strong indicator for high risk patients with higher expected mortality after hip fracture surgery. We saw no evidence to support delayed surgery in patients taking DOACs.
髋部骨折给发达国家的医疗保健系统带来了巨大负担。患者通常有多种合并症，并且在受伤前经常使用抗凝药物和抗血小板药物。
本研究使用单个医院髋部骨折数据库，方便对接受手术治疗的髋部骨折患者的抗凝和抗血小板治疗对死亡率和并发症的影响进行回顾性分析。华法林组有 92 例患者，直接口服抗凝剂（DOAC）组有 69 例，抗血小板组有 260 例，对照组有 617 例。
对照组 30 天死亡率为 4.8%，抗血小板组为 12.6%，华法林组为 7.0%，DOAC 组为 9.5%，p=0.004。对照组 1 年死亡率为 22.4%，抗血小板组为 32.3%，华法林组为 29.3%，DOAC 组为 29.0%（p=0.007）。在并发症方面，在输血（DOAC）和伤口渗血（华法林）率方面发现了显著差异，但研究并未发现这些差异带来显著的临床后果。为了更详细地研究死亡率数据，进行了年龄、性别和 ASA 的匹配分析。抗血小板药物治疗组的死亡率仍然存在差异，与死亡率增加相关，但差异似乎不再显著。我们的数据表明，这是一种非因果关系，可以纳入诺丁汉髋部骨折评分等预测死亡率风险评分。
我们认为，受伤前的抗血小板治疗是髋部骨折手术后预期死亡率较高的高危患者的一个重要指标。我们没有证据支持在服用 DOAC 的患者中延迟手术。
