CP-117 Risks of surgical intervention in patients taking oral anticoagulants

Abstract

BackgroundOral anticoagulants (OAC) play a crucial role in preventing thromboembolic diseases. However, these medications may carry numerous problems and risks while applied. Patients taking oral anticoagulants may have a higher risk of bleeding during a surgical intervention.PurposeOur aim was to analyse the risks that patients on oral anticoagulant therapy may have during their hospitalisation and surgical procedure.Material and methodsPatients were recruited from the traumatology department, admitted with osteoporotic hip fractures. A retrospective analysis was performed for the period between January 2011 and August 2012. Data were recorded from the patient charts and documentation. Data comparison was made regarding the risks of patients on OAC and of patients not taking oral anticoagulants (control group).Results510 patients were enrolled in this study (133 males, 377 females), mean age 79.68 ± 9.81 years (mean ± SD). On admission, 49 patients were taking OAC (14 males, 35 females, mean age 80.88 ± 10.04 years), which was acenocumarol. 119 men and 342 women (mean age 79.56 ± 7.22 years) were included in the control group. In the OAC group, more time elapsed between the admission date and the surgical procedure: 3.43 days (±2.30 days) versus 1.74 days (±2.21 days) in the control group (p ≤ 0.001). At the same time, there was no substantial difference in the length of operation between the two groups: 1 h 54 min versus 1 h 50 min. Following the surgical intervention, the mean length of hospital stay did not differ significantly between the two groups (11.24 days). Complications during the surgical procedure and/or hospital stay occurred in 57.1% in the OAC group and in 51.8% of controls. During the hospital stay, 53.1% of the OAC group received blood transfusion compared with 45.3% of the control group. Mortality rate was 8.16% in OAC patients versus 3.14% in the control group. Autopsy confirmed cause of mortality was not available.ConclusionAlthough the overall hospital stay did not differ significantly, considerable differences were seen regarding length of time elapsed until surgery, complication rate and mortality rate between the OAC and control groups. The higher mortality rate highlights the frailty of patients receiving oral anticoagulant therapy.No conflict of interest.

Effect of oral anticoagulants on hemostatic and thromboembolic complications in hip fracture: A systematic review and meta‐analysis

“…Of the 4015 abstracts identified following removal of duplicates, 3924 studies were excluded following title and abstract screening (Figure 1). Of the remaining 91 studies which underwent full‐text review, 21 studies were determined to be eligible and included in the systematic review 8,9,21‐39 . They comprised 7605 anticoagulated hip fracture patients and 13 812 non‐anticoagulated patients (Table 1).…”