Management of anticoagulation in hip fractures: A pragmatic approach

EFORT Open Reviews
Rafik YassaPaul Dunkow

Abstract

Hip fractures are common and increasing with an ageing population. In the United Kingdom, the national guidelines recommend operative intervention within 36 hours of diagnosis. However, long-term anticoagulant treatment is frequently encountered in these patients which can delay surgical intervention. Despite this, there are no set national standards for management of drug-induced coagulopathy pre-operatively in the context of hip fractures.The aim of this study was to evaluate the management protocols available in the current literature for the commonly encountered coagulopathy-inducing agents.We reviewed the current literature, identified the reversal agents used in coagulopathy management and assessed the evidence to determine the optimal timing, doses and routes of administration.Warfarin and other vitamin K antagonists (VKA) can be reversed effectively using vitamin K with a dose in the range of 2 mg to 10 mg intravenously to correct coagulopathy.The role of fresh frozen plasma is not clear from the current evidence while prothrombin complex remains a reliable and safe method for immediate reversal of VKA-induced coagulopathy in hip fracture surgery or failed vitamin K treatment reversal.The literature suggests that surger...Continue Reading

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Citations

May 22, 2018·EFORT Open Reviews·Dimitrios A FlevasAndreas F Mavrogenis
Jul 16, 2020·Journal of Clinical Medicine·Seth M TarrantZsolt J Balogh
Apr 19, 2020·Journal of Orthopaedic Trauma·Seth M TarrantZsolt J Balogh
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Sep 14, 2021·Archives of Orthopaedic and Trauma Surgery·Raphael KrespiAmal Khoury

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