Anticoagulation Management in Individuals with Hip Fracture

Gleason, Lauren J.; Mendelson, Daniel A.; Kates, Stephen L.; Friedman, Susan M.

doi:10.1111/jgs.12591

Cited by 46 publications

(28 citation statements)

References 30 publications

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“…The use of fresh-frozen plasma appears to be safe and significantly reduces time to surgical repair. 44,45 For patient taking newer anticoagulants like dabigatran, rivaroxaban and apixaban, there is no reversal therapy therefore, based on these products' package insert, a prudent time between the last dose of these medications and surgery is approximately 48 hours. This could be extended on patients with abnormal renal of hepatic function.…”

Section: Coagulopathiesmentioning

confidence: 99%

“…253,254 This system incorporates Codman 4 parts of the proximal humerus, namely, the anatomic head, the lesser tuberosity, greater tuberosity, and the humeral shaft ( Figure 10). 255 Displacement of more than 1 cm or angulation of the part by 45 or more allows the fragment to be counted as a part. Thus, a nondisplaced fracture would be zero parts and a fracture with displacement of greater than 1 cm of all 4 parts would be a 4-part fracture.…”

Section: Classificationmentioning

confidence: 99%

See 1 more Smart Citation

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

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131

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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Section: Coagulopathiesmentioning

confidence: 99%

Section: Classificationmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

Self Cite

131

121

View full text Add to dashboard Cite

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“…Recent studies have shown that early surgery in patients on clopidogrel and warfarin is safe with no increase in observed complications. [14][15][16] Removal of this delay would improve our time to surgery. Addition of a standardized pain management program and fracture prevention program may further improve our results.…”

Section: Discussionmentioning

confidence: 99%

Early Results of a Geriatric Hip Fracture Program in India for Femoral Neck Fracture

Jain

Selhi

Mears

et al. 2015

Geriatr Orthop Surg Rehabil

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Geriatric hip fractures are a challenging clinical problem throughout the world. Hip fracture services have been shown to shorten time to surgery, decrease the cost of admissions, and improve the outcomes. We instituted a geriatric hip fracture program for comanagement of these injuries by orthopedic and internal medicine teams at our hospital in India. From January 2010 till December 2011, 119 patients with a femoral neck fracture were treated with cemented modular hemiarthroplasty under this program using a cost-effective Indian implant. The cohort included 63 males and 56 females with a mean age of 70.7 years (range 55-98 years). Hypertension (n ¼ 42) and diabetes mellitus (n ¼ 29) were the most common comorbidities. The follow-up period ranged from 12 to 37 months with an average of 24 months. The surgery was performed within 24 hours of admission in 60.5% (n ¼ 72) patients. The use of antiplatelet drugs was the most common reason for delay of surgery. The mean length of hospital stay was 10.4 days (range 3-24 days) with 77% (n ¼ 92) of patients discharged within 1 week of admission. On follow-up, good to excellent Harris hip scores were seen in 88% of patients with 76% of patients returning to the preinjury ambulatory status. The mortality rate was 6% at 6 months follow-up and 10.9% at 2 years. Our study shows that a hip fracture program can be instituted in India. The program helped us in achieving the goal of early surgery, mobilization, and discharge from hospital with decreased mortality.

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“…Similarly, the process of implementing warfarin reversal guidelines within hospital systems requires interdisciplinary collaboration between emergency room doctors, surgeons, medicine doctors, anesthesiologists, and nursing staff. In this context, the implementation of geriatric trauma centers seems to be a promising concept that may facilitate process improvements within this specific patient population [2,4].…”

Section: How Do We Get There?mentioning

confidence: 99%

“…Different approaches for warfarin reversal in patients with hip fracture have been suggested [1,2,[5][6][7][8]10]. Available options include prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), and vitamin K [7].…”

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confidence: 99%