ArticleEFORT open reviews2017
Management of anticoagulation in hip fractures: A pragmatic approach.
Article in EFORT open reviews, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed, 44 citations in OpenAlex.
- Best practices in the management of proximal femoral fractures in elderly patients on the ward: a narrative review.EFORT open reviews · 2026Review
- Article
- Is regional only anesthesia a safe choice in anticoagulated hip fracture patients?European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Advancements in the Optimization of Surgical Timing in Elderly Patients with Hip Fractures: A Narrative Review and Future Perspectives.Clinical interventions in aging · 2025Review
- Key Considerations for Frail Patients Undergoing Hip Fracture Surgery.Clinics and practice · 2024Review
- Evaluation of a Blood Reserve Protocol for Hip Fracture Surgery in the Elderly.Revista brasileira de ortopedia · 2024Article
- Aortic Stenosis Management in Patients With Acute Hip Fracture.JACC. Advances · 2024Review
- Perioperative Management of Traditional and Direct Oral Anticoagulants in Hip Fracture Patients.Orthopedic reviews · 2024Article
- Early hip fracture surgery is safe for patients on direct oral anticoagulants.OTA international : the open access journal of orthopaedic trauma · 2023Article
- The Effect of Warfarin Use on Postoperative Outcomes after Femoral Neck Surgery.Journal of clinical medicine · 2023Article
- Early versus delayed surgery for hip fragility fractures in patients treated with direct oral anticoagulants.Archives of orthopaedic and trauma surgery · 2022Article
- Article
- Timing of Surgery for Hip Fracture in Patients on Direct Oral Anti-coagulants: A Population-Based Cohort Study.Geriatric orthopaedic surgery & rehabilitation · 2022Article
- Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus.Aging clinical and experimental research · 2021Review
- Partial warfarin reversal prior to hip fracture surgical intervention in geriatric trauma patients effects on blood loss and transfusions.Journal of clinical orthopaedics and trauma · 2021Article
- Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty.Medicina (Kaunas, Lithuania) · 2021Review
- Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study.Geriatric orthopaedic surgery & rehabilitation · 2021Article
- A Basic Intervention to Improve Compliance With Thromboprophylaxis in Patients With Neck of Femur Fracture.Ochsner journal · 2021Article
- Proximal femur fractures in patients taking anticoagulants.EFORT open reviews · 2020Review
- Direct Oral Anticoagulants and Timing of Hip Fracture Surgery.Journal of clinical medicine · 2020Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
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 surgery should not be delayed in patients on classical antiplatelet medications (aspirin or clopidogrel), but spinal or regional anaesthetic methods should be avoided for the latter. However, evidence regarding the use of more novel antiplatelet medications (e.g. ticagrelor) and direct oral anticoagulants remains a largely unexplored area in the context of hip fracture surgery. We suggest treatment protocols based on best available evidence and guidance from allied specialties.Hip fracture surgery presents a common management dilemma where semi-urgent surgery is required. In this article, we advocate an evidence-based algorithm as a guide for managing these anticoagulated patients. Cite this article:
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