髋部骨折患者的慢性华法林抗凝会延迟手术，并与术后并发症风险增加相关：一项多中心倾向评分匹配分析。

Chronic Warfarin Anticoagulation in Hip Fracture Patients Delays Surgery and Is Associated With Increased Risk of Postoperative Complications: A Multicenter Propensity-Score-Matched Analysis.

机构信息

Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL.

Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY.

出版信息

J Orthop Trauma. 2023 Feb 1;37(2):57-63. doi: 10.1097/BOT.0000000000002484.

DOI:10.1097/BOT.0000000000002484

PMID:36048739

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9868061/

Abstract

OBJECTIVE

To evaluate the effect of warfarin on blood transfusion and postoperative complications in a low-energy hip fracture population compared with a non-anticoagulated comparison group.

DESIGN

Multicenter Retrospective Cohort.

SETTING

Three Urban Level I Academic Trauma Centers.

PATIENTS

Acute, low-energy, native hip fractures in patients 55 years of age or older on chronic warfarin anticoagulation, propensity score matched 1:2 to non-anticoagulated hip fracture patients meeting all other inclusion criteria.

MAIN OUTCOME MEASUREMENTS

Transfusion and postoperative complication rates.

RESULTS

Two hundred ten anticoagulated hip fracture patients were matched to 420 nonanticoagulated patients. A higher proportion of patients required blood transfusion in the warfarin cohort (52.4% vs. 43.3%, P < 0.001), attributable mostly to the subgroup of patients undergoing arthroplasty. Warfarin patients had higher incidence of overall 90-day complications (47% vs. 38%, P = 0.039) and readmissions (31.4% vs. 8.9%, P < 0.001). Day of surgery international normalized ratio (INR) did not influence transfusions or complications among warfarin patients. Warfarin patients undergoing surgery within 24 hours had no difference in transfusions and had fewer complications compared with those undergoing surgery after 24 hours. On multivariable logistic regression analysis, warfarin use and day of surgery INR were not predictors of transfusion or complications.

CONCLUSIONS

Patients on warfarin experienced longer time to surgery and higher incidence of overall transfusion and postoperative complications within 90 days of surgery. However, warfarin use and day of surgery INR was not independently associated with transfusions or complications. The reason for poorer outcomes in warfarin patients remains a topic of further investigation.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

评估与未抗凝的对照组相比，低能量髋部骨折患者中使用华法林对输血和术后并发症的影响。

设计

多中心回顾性队列研究。

地点

三家城市一级学术创伤中心。

患者

年龄在 55 岁或以上，长期接受华法林抗凝治疗的急性、低能量、原发性髋部骨折患者，根据所有其他纳入标准，与未接受抗凝治疗的髋部骨折患者进行倾向性评分 1:2 匹配。

主要观察指标

输血和术后并发症发生率。

结果

210 例抗凝髋部骨折患者与 420 例未抗凝患者相匹配。华法林组患者需要输血的比例更高（52.4% vs. 43.3%，P<0.001），这主要归因于接受关节置换术的患者亚组。华法林组患者在 90 天内总体并发症（47% vs. 38%，P=0.039）和再入院率（31.4% vs. 8.9%，P<0.001）更高。手术当天的国际标准化比值（INR）对华法林患者的输血或并发症没有影响。手术在 24 小时内进行的华法林患者与手术在 24 小时后进行的患者相比，输血没有差异，并发症也更少。在多变量逻辑回归分析中，华法林的使用和手术当天的 INR 不是输血或并发症的预测因素。