Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 4, April, p. 469–477

doi: 10.17219/acem/78025

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Bridging anticoagulation in patients treated with vitamin K antagonists prior to trochanteric and hip fracture surgeries: The current practice

Krzysztof Szklanny1,A,B,C,D, Michał Jakubek1,B,C,D, Katarzyna Zbierska-Rubinkiewicz2,C,D,E, Anetta Undas3,4,A,E,F

1 Department of Orthopedics, St. Lucas Hospital in Tarnów, Poland

2 Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland

3 Center for Medical Research and Technology, John Paul II Hospital, Kraków, Poland

4 Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland

Abstract

Background. The strategies of perioperative bridging anticoagulation in orthopedic surgical patients during oral anticoagulation (OAC) therapy with vitamin K antagonists (VKA) vary from center to center.
Objectives. The aim of this single-center study was to assess the risk of bleeding and thromboembolic events (TEs) in bridged patients on VKA who underwent orthopedic surgery due to trochanteric or hip fracture.
Material and Methods. The retrospective study included 64 patients (mean age: 80 years) who received VKA for at least 3 months prior to orthopedic procedure. All subjects were bridged with enoxaparin (40 mg once a day). The control group (n = 69) comprised of age-, sexand procedure-matched patients operated on for the same indications, but with neither a history of VKA therapy nor perioperative bridging anticoagulation.
Results. Severe postoperative bleeding occurred in 19 (29.7%) patients from the VKA group and in 13 (18.8%) controls (p = 0.16). Within the VKA group, intertrochanteric fractures (52.6%) and femoral neck fractures (47.4%) occurred more often in patients with bleeding than other lower extremity fractures (0%; p = 0.03). Severe adverse events (SAEs) were more common in the VKA group than in the controls (12.5% vs 1.5%; p = 0.01). Patients from the VKA group did not differ from the controls in the incidence of TEs (6.3% vs 8.9%; p = 0.31). No intrahospital mortality was documented.
Conclusion. Prophylactic administration of enoxaparin is a common strategy of bridging anticoagulation in a hospital setting. This approach does not seem to be associated with an increase in thromboembolic risk nor higher risk of bleeding in orthopedic patients who received VKA preoperatively.

Key words

anticoagulation, low molecular weight heparin, vitamin K antagonists, bridging therapy, trochanteric and hip neck fracture surgery

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