Table of Contents
ISRN Hematology
Volume 2011 (2011), Article ID 294628, 5 pages
http://dx.doi.org/10.5402/2011/294628
Clinical Study

Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

1Queen Alexandra Hospital, Portsmouth, UK
2Northern General Hospital, Sheffield, UK
3Colchester General Hospital, Colchester, UK
4Great Western Hospital, Swindon, UK

Received 11 October 2010; Accepted 5 December 2010

Academic Editors: R. M. Camire, M. Morfini, M. Sugimoto, and B. Wachowicz

Copyright © 2011 Feras Ashouri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant ( ๐‘ƒ < . 0 1 ). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.