比较使用凝血酶原复合物浓缩物和维生素 K 逆转维生素 K 拮抗剂策略与髋部骨折患者的安全性和疗效。
Safety and efficacy of a strategy of vitamin K antagonist reversal with prothrombin complex concentrates compared to vitamin K in patients with hip fracture.
机构信息
From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David).
出版信息
Can J Surg. 2021 Jun 4;64(3):E330-E338. doi: 10.1503/cjs.002120.
BACKGROUND
Increased preoperative delay in patients with hip fractures may be responsible for increased morbidity and mortality. We hypothesized that a strategy of reversal of vitamin K antagonist (VKA) by prothrombin complexes concentrates (PCCs), as compared to vitamin K, is safe and reduces preoperative delay and hospital length of stay (LOS).
METHODS
In this pilot study, we reviewed the records of patients admitted to a university-affiliated hospital for hip fracture between Jan. 1, 2012, and Dec. 31, 2016, who were taking VKA. Patients were stratified according to reversal strategy (vitamin K v. PCC). Adverse effects, time to surgery, LOS and mortality were collected from the electronic medical record and were compared between the 2 study groups and a control group not treated with VKA.
RESULTS
A total of 141 patients were included in the study: 65 in the vitamin K group, 26 in the PCC group and 50 in the control group. The median preoperative delay in the PCC group (20 h [interquartile range (IQR)] 13-25 h]) and the control group (20 h [IQR 15-33 h]) was lower than that in the vitamin K group (45 h [IQR 31-52 h]) (p < 0.001). Patients in the PCC group had a shorter median hospital LOS than those in the vitamin K group (6 d [IQR 4-9 d] v. 8 d [IQR 6-11 d], p < 0.05). No difference was observed in the proportion of patients who received a red blood cell transfusion, or had thrombotic or hemorrhagic complications. No difference in mortality at 12 months was observed between the groups.
CONCLUSION
In patients with hip fracture, the use of PCCs as compared to vitamin K to reverse the effect of VKA significantly reduced preoperative delay and hospital LOS, and was not associated with an increase in the rates of thrombotic or hemorrhagic complications. Prospective studies involving a greater number of patients are required to confirm these promising results.
背景
髋部骨折患者术前等待时间的增加可能导致发病率和死亡率的增加。我们假设与维生素 K 相比，使用凝血酶原复合物浓缩物（PCC）逆转维生素 K 拮抗剂（VKA）的策略是安全的，可以减少术前等待时间和住院时间（LOS）。
方法
在这项试点研究中，我们回顾了 2012 年 1 月 1 日至 2016 年 12 月 31 日期间因髋部骨折入住一所大学附属医院的接受 VKA 治疗的患者的病历。根据逆转策略（维生素 K 与 PCC）对患者进行分层。从电子病历中收集不良事件、手术时间、住院时间和死亡率，并在 2 个研究组和未接受 VKA 治疗的对照组之间进行比较。
结果
共纳入 141 例患者：维生素 K 组 65 例，PCC 组 26 例，对照组 50 例。PCC 组（20 h [四分位距 (IQR) 13-25 h]）和对照组（20 h [IQR 15-33 h]）的术前等待时间中位数低于维生素 K 组（45 h [IQR 31-52 h]）（p < 0.001）。PCC 组的住院时间中位数短于维生素 K 组（6 d [IQR 4-9 d] 比 8 d [IQR 6-11 d]，p < 0.05）。两组患者接受红细胞输注、血栓或出血并发症的比例无差异。各组在 12 个月时的死亡率无差异。
结论
与维生素 K 相比，髋部骨折患者使用 PCC 逆转 VKA 的效果可显著减少术前等待时间和住院时间，且不会增加血栓或出血并发症的发生率。需要进行涉及更多患者的前瞻性研究来证实这些有前景的结果。
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