ArticleGeriatric orthopaedic surgery & rehabilitation2014
"Tiers of delay": warfarin, hip fractures, and target-driven care.
Article in Geriatric orthopaedic surgery & rehabilitation, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed.
- The management of anticoagulated fragility femoral fracture patients.Hip international : the journal of clinical and experimental research on hip pathology and therapy · 2024Review
- Management and 1-Year Outcome in Elderly Patients with Hip Fracture Surgery Receiving Anticoagulation (Warfarin or DOAc) or P2Y12 Antiplatelet Agents.Journal of clinical medicine · 2023Article
- The Effect of Warfarin Use on Postoperative Outcomes after Femoral Neck Surgery.Journal of clinical medicine · 2023Article
- The Perioperative Management of Antiplatelet and Anticoagulant Drugs in Hip Fractures: Do the Surgery as Early as Possible.The archives of bone and joint surgery · 2022Review
- Proximal femur fractures in patients taking anti-coagulants: has anything changed?EFORT open reviews · 2022Review
- Management of ongoing direct anticoagulant treatment in patients with hip fracture.Scientific reports · 2021Observational
- Proximal femur fractures in patients taking anticoagulants.EFORT open reviews · 2020Review
- Do direct oral anticoagulants (DOACs) cause delayed surgery, longer length of hospital stay, and poorer outcome for hip fracture patients?European geriatric medicine · 2020Article
- Impact of anticoagulants in elderly patients who suffer a hip fracture. Should we have a different approach?Acta bio-medica : Atenei Parmensis · 2020Article
- Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis.Archives of orthopaedic and trauma surgery · 2020Article
- Hip Fractures: Therapy, Timing, and Complication Spectrum.Orthopaedic surgery · 2019Article
- Review
- The Fascia Iliaca Block as the Primary Intraoperative Anesthesia for Hip Fracture Surgery: A Preliminary Study.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2018Article
- Does Use of Oral Anticoagulants at the Time of Admission Affect Outcomes Following Hip Fracture.Geriatric orthopaedic surgery & rehabilitation · 2018Article
- Use of Anticoagulants Remains a Significant Threat to Timely Hip Fracture Surgery.Geriatric orthopaedic surgery & rehabilitation · 2018Article
- Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?Clinical orthopaedics and related research · 2017Article
- Anticoagulation therapy and proximal femoral fracture treatment: An update.EFORT open reviews · 2016Article
- "Early Trigger" Intravenous Vitamin K: Optimizing Target-Driven Care in Warfarinised Patients With Hip Fracture.Geriatric orthopaedic surgery & rehabilitation · 2015Article
- Current Practices Regarding Perioperative Management of Patients With Fracture on Antiplatelet Therapy: A Survey of Orthopedic Surgeons.Geriatric orthopaedic surgery & rehabilitation · 2015Article
- A Stab in the Dark? Point-of-Care Testing in the Population With Hip Fracture.Geriatric orthopaedic surgery & rehabilitation · 2015Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Anticoagulation reversal is a common cause of operative delay. We sought to establish for the first time the impact this has on best practice tariff (BPT) for patients with hip fracture admitted on warfarin. All patients with hip fracture treated operatively over a 32-month period were reviewed. Basic demographics, time to theater, length of stay, and mortality were recorded for all patients. Independent samples t-tests were used to identify statistically significant differences between patients on warfarin and those not taking the drug. A total of 83 patients were admitted anticoagulated with a mean international normalized ratio of 2.65 and a median time to theater of 49.7 hours. Of these patients, 79% breached BPT, incurring significant financial loss. In the control group, 908 patients took a median 24.5 hours, a 28% breach of BPT (P < .01). Length of stay, Nottingham Hip Fracture Score, and predicted 30-day mortality were similar for both the groups. As well as affecting clinical outcome following hip fracture, delay due to anticoagulation causes considerable loss of BPT. Potential loss of revenue due to delays over the study period was £80 000, inspiring the establishment of an "early trigger" anticoagulation protocol. Although it is accepted that there are limitations to this work, it should raise awareness of the real impact of warfarin on patients with hip fracture both in terms of outcome and for the first time, loss of potential revenue.
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