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The impact of anticoagulant medications on fragility femur fracture care : The Hip and Femoral Fracture Anticoagulation Surgical Timing Evaluation (Haste) Study
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Farhan-Alanie, M. M., Chinweze, R., Walker, R. and Eardley, W. G. P. (2024) The impact of anticoagulant medications on fragility femur fracture care : The Hip and Femoral Fracture Anticoagulation Surgical Timing Evaluation (Haste) Study. Injury . 111451. doi:10.1016/j.injury.2024.111451 ISSN 0020-1383. (In Press)
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Official URL: http://dx.doi.org/10.1016/j.injury.2024.111451
Abstract
Introduction:
Due to their hypocoagulable state on presentation, anticoagulated patients with femoral fragility fractures typically experience delays to surgery. There are no large, multicentre studies previously carried out within the United Kingdom (UK) evaluating the impact of anticoagulant use in this patient population. This study aimed to evaluate the current epidemiology and compare the perioperative management of anticoagulated and non-anticoagulated femoral fragility fracture patients.
Methods:
Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the United Kingdom. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Main outcomes under investigation included time to surgery, receipt of blood transfusion between admission and 48 hours following surgery, length of stay, and 30-day mortality. These were assessed using multivariable linear and logistic regression, and Cox proportional hazards models. Only data from hospitals ≥90% case ascertainment with reference to figures from the National Hip Fracture Database (NHFD) were analysed.
Results:
Data on 10,197 patients from 78 hospitals were analysed. 18.5% of patients were taking anticoagulants. Compared to non-anticoagulated patients, time to surgery was longer by 7.59 hours (95%CI 4.83–10.36; p<0.001). 42.41% of anticoagulated patients received surgery within 36 hours (OR 0.54, 95%CI 0.48-0.60, p<0.001). Differences in time to surgery were similar between countries however there was some variation across units. There were no differences in blood transfusion and length of stay between groups (OR 1.03, 95%CI 0.88–1.22, p=0.646 and 0.22 days, 95%CI -4.48–0.887; p=0.887 respectively). Mortality within 30 days of admission was higher in anticoagulated patients (HR 1.27, 95%CI 1.03–1.57, p=0.026).
Conclusions:
Anticoagulated femoral fragility fracture patients comprise a substantial number of patients, and experience relatively longer delays to surgery with less than half receiving surgery within 36 hours of admission. This may have resulted in their comparatively higher mortality rate. Inclusion of anticoagulation status in the minimum data set for the NHFD to enable routine auditing of performance, and development of a national guideline on the management of this growing and emerging patient group is likely to help standardise practice in this area and improve outcomes.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
Library of Congress Subject Headings (LCSH): | Fractures -- Treatment, Femur -- Fractures -- Treatment, Hip joint -- Surgery -- Research, Osteoporosis, Anticoagulants (Medicine) , Blood -- Coagulation, Oral medication, Evidence-based medicine, Surgery, Operative -- Standards | ||||||
Journal or Publication Title: | Injury | ||||||
Publisher: | Elsevier | ||||||
ISSN: | 0020-1383 | ||||||
Official Date: | 27 February 2024 | ||||||
Dates: |
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Article Number: | 111451 | ||||||
DOI: | 10.1016/j.injury.2024.111451 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | In Press | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 28 February 2024 | ||||||
Date of first compliant Open Access: | 29 February 2024 | ||||||
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