Influence of timing and oral anticoagulant/antiplatelet therapy on outcomes of patients affected by hip fractures

Background Patients undergoing surgical procedures are usually asked to discontinue any anticoagulant/antiplatelet therapy and delay surgery for at least 5 days to reduce the risk of major bleeding and spinal hematoma. Patients and methods The purpose of this study was to determine if this strategy is suitable for patients on anticoagulant/antiplatelet therapy affected by a hip fracture, evaluating the effect of anticoagulant/antiplatelet therapy and surgical timing on mortality and complication rates for patients affected by a hip fracture. We performed an observational study on patients referring to our hospital for a hip fracture. We evaluated patients on warfarin, ticlopidine, and aspirin therapy matched to patients not on anticoagulant or antiplatelet therapy, out of 875 consecutive patients treated for a hip fracture in a 5-year period. Blood loss, blood transfusions, length of hospitalization, walking ability, complications, and mortality at 1 year of follow-up were recorded. Kruskal-Wallis, Mann-Whitney U, and logistic regression statistical tests were performed. Results Patients on warfarin therapy operated more than 5 days after admission showed significantly higher complication and mortality rates compared to all other patients. Two critical factors were identified: warfarin therapy and excessive time to surgery; these factors are not significant if taken alone, while they become a high-risk factor if taken together. Conclusion The "discontinue drug, and delay surgery" strategy is not suitable for patients on anticoagulant (warfarin) therapy affected by a hip fracture.