Chronic Warfarin Anticoagulation in Hip Fracture Patients Delays Surgery and is Associated with Increased Risk of Postoperative Complications: A Multicenter Propensity Score Matched Analysis. Journal Article

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Authors: Levack, AE; Moore, HG; Stephan, SR; Jo, S; Schroeder, IG; Garlich, JM; Hadad, A; Little, MTM; Miller, AN; Lyman, S; Lane, JM
Article Title: Chronic Warfarin Anticoagulation in Hip Fracture Patients Delays Surgery and is Associated with Increased Risk of Postoperative Complications: A Multicenter Propensity Score Matched Analysis.
Abstract: OBJECTIVE: To evaluate the effect of warfarin on blood transfusion and postoperative complications in a low energy hip fracture population compared to 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: 210 anticoagulated hip fracture patients were matched to 420 non-anticoagulated patients. A higher proportion of patients required blood transfusion in the warfarin cohort (52.4% vs. 43.3%, p0.001), 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 to 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: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Journal Title: Journal of orthopaedic trauma
ISSN: 1531-2291; 0890-5339
Publisher: Unknown  
Date Published: 2022
LUC Authors
  1. Ashley Levack
    21 Levack
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