An evidence-based warfarin management protocol reduces surgical delay in hip fracture patients

J Orthop Traumatol. 2014 Mar;15(1):21-7. doi: 10.1007/s10195-013-0274-7. Epub 2013 Nov 26.

Abstract

Background: Up to 4% of patients presenting with a hip fracture may be on warfarin at admission. There is little consensus on the timing, dosage or route of vitamin K administration. We aimed to evaluate the impact of a locally developed, evidence-based protocol for perioperative warfarin management on the admission-to-operation time (AOT) in hip fracture patients.

Materials and methods: Clinical and demographic data were collected prospectively for hip fracture patients who were on warfarin at the time of admission (post-protocol group) and compared to a historical control group of patients who were on warfarin before implementation of the protocol (pre-protocol group). Univariate analysis was undertaken to identify any significant differences between the two groups.

Results: Twenty-seven patients in the pre-protocol group (27/616, 4.4%) and 40 patients in the post-protocol group (4.7%, 40/855) were on warfarin at admission. There was a significant reduction in the median AOT from 73 h (IQR 46-105) to 37.7 h (IQR 28-45) after implementation of the warfarin protocol (p < 0.001). The proportion of patients operated on within 48 h of admission increased from 30% (8/27) in the pre-protocol group to 80% (32/40) in the post-protocol group (p < 0.001). No significant differences in hospital length of stay (p = 0.77) or the postoperative warfarin recommencement time (p = 0.90) were noted between the two groups.

Conclusion: Implementation of a perioperative warfarin management protocol can expedite surgery in hip fracture patients, but did not reduce hospital stay in our cohort, possibly because of a delay in recommencing warfarin in these patients postoperatively.

Level of evidence: Level III.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage*
  • Antifibrinolytic Agents / administration & dosage*
  • Drug Therapy, Combination
  • Evidence-Based Medicine
  • Female
  • Follow-Up Studies
  • Hip Fractures / surgery*
  • Humans
  • Length of Stay
  • Male
  • Perioperative Period
  • Prospective Studies
  • Retrospective Studies
  • Risk Assessment / methods
  • Time-to-Treatment
  • Treatment Outcome
  • Vitamin K / administration & dosage*
  • Warfarin / administration & dosage*

Substances

  • Anticoagulants
  • Antifibrinolytic Agents
  • Vitamin K
  • Warfarin