Higher Education | Internal Medicine | Medicine and Health Sciences | Orthopedics
BACKGROUND: The purpose of our study is to evaluate if surgical intervention in the setting of an elevated INR or continued use of clopidogrel lead to elevated post-operative mortality and/or morbidity compared to INR reversal or surgical delay.
METHODS: We retrospectively reviewed 1,007 patients age > 55 undergoing hip fracture fixation at our institution over a 10 year span. We placed patients into four groups based upon their anticoagulation status at the time of surgery. Descriptive statistics were utilized to evaluate for differences in mortality rates, blood loss, time to surgery, and wound complications.
RESULTS: Comorbid conditions occurred at a higher rate in patients on an anticoagulant. There was found to be no difference (p>.05) between all four groups in regards to units of blood transfused, net preoperative to post-operative hemoglobin change, 30 day mortality, wound infections, and post-operative thromboembolic events. Average time to surgery was less than two days for all groups.
CONCLUSION: There was no statistically significant increase in local or systemic complications in patients who underwent surgery in the setting of an INR > 1.5 or continued use of clopidogrel. Our study supports the finding that appropriate and attentive management of anticoagulants from the time of admission can minimize surgical delays and result in time to surgery in less than two days for patients with an elevated INR at the time of presentation with no effect on mortality or morbidity.
hip fracture, geriatric, clopidogrel, warfarin, surgical timing
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Locker, J., Lyden, E., , Siebler, J. Postoperative Outcomes of Hip Fracture Surgery in Geriatric Patients on Clopidogrel or Warfarin at the Time of Surgery. Graduate Medical Education Research Journal. 2021 Oct 04; 3(1).