The Perioperative Management of Antiplatelet and Anticoagulant Drugs in Hip Fractures: Do the Surgery as Early as Possible

Document Type : CURRENT CONCEPTS REVIEW

Authors

1 Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran

2 1 Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran 2 School of Medicine, Tehran University of Medical Science, Tehran, Iran

Abstract

Hip fractures are among the most common fractures operated by orthopedic surgeons. Many elderly patients, who 
account for a significant percentage of hip fractures, suffer from medical conditions requiring antiplatelet and anticoagulant 
administration. Meanwhile, considerable evidence recommends early surgery within 48b hours of admission. We aim 
to review the existing evidence regarding the perioperative management of antiplatelet and anticoagulant drugs in hip 
fractures. It was concluded that surgery for hip fractures in patients with antiplatelet drug consumption should not be 
delayed unless a clear contraindication exists. Active reversal strategies are indicated for patients with hip fractures and 
warfarin therapy. However, evidence for the safety of these agents in pregnancy, breastfeeding state, and adolescence 
has not yet been established. Little data exists about perioperative management of direct-acting oral anticoagulants in 
hip fractures. Early surgery after 12-24 hours of drug cessation has been suggested in studies; however, it should be 
employed cautiously. Despite extensive research, the importance of the issue necessitates additional higher-quality 
studies.
Level of evidence: V

Keywords

References

  1. Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD. Rockwood and Green’s fractures in adults. Wolters Kluwer Health; 2015. https://www.worldcat.org/title/rockwood-and-greens-fractures-in-adults/oclc/878915244
  2. Ftouh S, Morga A, Swift C. Management of hip fracture in adults: summary of NICE guidance. BMJ (Clinical research ed). 2011; 342:d3304.
  3. Leung F, Lau TW, Kwan K, Chow SP, Kung AW. Does timing of surgery matter in fragility hip fractures? Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2010;21(Suppl 4):S529-34.
  4. Ryan DJ, Yoshihara H, Yoneoka D, Egol KA, Zuckerman JD. Delay in Hip Fracture Surgery: An Analysis of Patient-Specific and Hospital-Specific Risk Factors. Journal of orthopaedic trauma. 2015;29(8):343-8.
  5. Casaletto JA, Gatt R. Post-operative mortality related to waiting time for hip fracture surgery. Injury. 2004;35(2):114-20.
  6. Shiga T, Wajima ZI, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Canadian Journal of Anesthesia. 2008;55(3):146-54.
  7. Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? The Journal of bone and joint surgery American volume. 2005;87(3):483-9.
  8. Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ (Clinical research ed). 2006;332(7547):947-51. SIGN. Management of hip fracture in older people. SIGN 111, 2009.
  9. sign.ac.uk/sign-111-management-of-hip-fracture-inolder-people.html (2009, accessed 26 September 2016).
  10. Diament M, MacLeod K, O’Hare J, Tate A, Eardley W. “Early Trigger” Intravenous Vitamin K: Optimizing Target-Driven Care in Warfarinised Patients With Hip Fracture. Geriatric orthopaedic surgery & rehabilitation. 2015;6(4):263-8.
  11. Al-Rashid M, Parker MJ. Anticoagulation management in hip fracture patients on warfarin. Injury. 2005;36(11):1311-5.
  12. Oprea AD, Popescu WM. Perioperative management of antiplatelet therapy. BJA: British Journal of Anaesthesia. 2013;111(suppl_1):i3-i17.
  13. Kragh AM, Walden M, Apelqvist A, Wagner P, Atroshi I. Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study. BMC musculoskeletal disorders. 2011;12:254.
  14. Manning BJ, O’Brien N, Aravindan S, Cahill RA, McGreal G, Redmond HP. The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures. Injury. 2004;35(2):121-4.
  15. Kennedy MT, Roche S, Fleming SM, Lenehan B, Curtin W. The association between aspirin and blood loss in hip fracture patients. Acta orthopaedica Belgica. 2006;72(1):29-33.
  16. Chechik O, Thein R, Fichman G, Haim A, Tov TB, Steinberg EL. The effect of clopidogrel and aspirin on blood loss in hip fracture surgery. Injury. 2011;42(11):1277-82.
  17. Anekstein Y, Tamir E, Halperin N, Mirovsky Y. Aspirin therapy and bleeding during proximal femoral fracture surgery. Clinical orthopaedics and related research. 2004(418):205-8.
  18. Tran T, Delluc A, de Wit C, Petrcich W, Le Gal G, Carrier M. The impact of oral anticoagulation on time to surgery in patients hospitalized with hip fracture. Thromb Res. 2015;136(5):962-5.
  19. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e326S-e50S.
  20. Griffiths R, Alper J, Beckingsale A, Goldhill D, Heyburn G, Holloway J, et al. Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2012;67(1):85-98.
  21. Keeling D, Tait RC, Watson H, Haematology tBCoSf. Peri-operative management of anticoagulation and antiplatelet therapy. British Journal of Haematology. 2016;175(4):602-13.
  22. Nwachuku IC, Jones M, Clough TM. Clopidogrel: is a surgical delay necessary in fractured neck of femur? Annals of the Royal College of Surgeons of England. 2011;93(4):310-3.
  23. Chechik O, Amar E, Khashan M, Kadar A, Rosenblatt Y, Maman E. In support of early surgery for hip fractures sustained by elderly patients taking clopidogrel: a retrospective study. Drugs & aging. 2012;29(1):63-8.
  24. Collyer TC, Reynolds HC, Truyens E, Kilshaw L, Corcoran T. Perioperative management of clopidogrel therapy: the effects on in-hospital cardiac morbidity in older patients with hip fractures. British journal of anaesthesia. 2011;107(6):911-5.
  25. Leonidou A, Cam NB, Chambers IR. Femoral neck fractures in patients on Clopidogrel. The effect of delaying surgery and the introduction of the new SIGN guidelines. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 2011;9(6):318-21.
  26. Maheshwari R, Acharya M, Monda M, Pandey R. Factors influencing mortality in patients on antiplatelet agents presenting with proximal femoral fractures. Journal of orthopaedic surgery (Hong Kong). 2011;19(3):314-6.
  27. Wallace HC, Probe RA, Chaput CD, Patel KV. Operative treatment of hip fractures in patients on clopidogrel: a case-control study. The Iowa orthopaedic journal. 2012;32:95-9.
  28. Feely MA, Mabry TM, Lohse CM, Sems SA, Mauck KF. Safety of clopidogrel in hip fracture surgery. Mayo Clinic proceedings. 2013;88(2):149-56.
  29. Hossain FS, Rambani R, Ribee H, Koch L. Is discontinuation of clopidogrel necessary for intracapsular hip fracture surgery? Analysis of 102 hemiarthroplasties. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology. 2013;14(3):171-7.
  30. McBrien ME, Heyburn G, Lappin E, McGuirk S, McBrien JL, Stevenson M, et al. Multidisciplinary guideline for hip fracture patients taking clopidogrel. Anaesthesia. 2013;68(1):116-8.
  31. Wordsworth DR, Halsey T, Griffiths R, Parker MJ. Clopidogrel has no effect on mortality from hip fracture. Injury. 2013;44(6):743-6.
  32. Madsen CM, Jorgensen HL, Norgaard A, Riis T, Jantzen C, Pedersen OB, et al. Preoperative factors associated with red blood cell transfusion in hip fracture patients. Archives of orthopaedic and trauma surgery. 2014;134(3):375-82.
  33. Manaqibwala MI, Butler KA, Sagebien CA. Complications of hip fracture surgery on patients receiving clopidogrel therapy. Archives of orthopaedic and trauma surgery. 2014;134(6):747-53.
  34. Clareus A, Fredriksson I, Wallen H, Gordon M, Stark A, Skoldenberg O. Variability of platelet aggregation in patients with clopidogrel treatment and hip fracture: A retrospective case-control study on 112 patients. World journal of orthopedics. 2015;6(5):439-45.
  35. Sa-Ngasoongsong P, Kulachote N, Sirisreetreerux N, Chanplakorn P, Laohajaroensombat S, Pinsiranon N, et al. Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents. World journal of orthopedics. 2015;6(11):970-6.
  36. Zehir S, Zehir R, Sarak T. Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy. Acta orthopaedica et traumatologica turcica. 2015;49(3):249-54.
  37. Purushothaman B, Webb M, Weusten A, Bonczek S, Ramaskandhan J, Nanu A. Decision making on timing of surgery for hip fracture patients on clopidogrel. Annals of the Royal College of Surgeons of England. 2016;98(2):91-5.
  38. Ghanem ES, Richard RD, Wingert NCH, Gotoff JR, Graham JH, Bowen TR. Preoperative Use of Clopidogrel Does Not Affect Outcomes for Femoral Neck Fractures Treated With Hemiarthroplasty. The Journal of arthroplasty. 2017;32(7):2171-5.
  39. Jang CY, Kwak DK, Kim DH, Lee HM, Hwang JH, Yoo JH. Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue? 2019;20(1):124.
  40. Pailleret C, Ait Hamou Z, Rosencher N, Samama CM, Eyraud V, Chilot F, et al. A retrospective comparison between delayed and early hip fracture surgery in patients taking clopidogrel: same total bleeding but different timing of blood transfusion. International orthopaedics. 2017;41(9):1839-44.
  41. Lott A, Haglin J, Belayneh R, Konda SR, Leucht P, Egol KA. Surgical Delay Is Not Warranted for Patients With Hip Fractures Receiving Non-Warfarin Anticoagulants. Orthopedics. 2019:1-5.
  42. Mattesi L, Noailles T, Rosencher N, Rouvillain JL. Discontinuation of Plavix((R)) (clopidogrel) for hip fracture surgery. A systematic review of the literature. Journal of orthopaedic surgery and research. 2016;102(8):1097-101.
  43. Soo CG, Della Torre PK, Yolland TJ, Shatwell MA. Clopidogrel and hip fractures, is it safe? A systematic review and meta-analysis. BMC musculoskeletal disorders. 2016;17:136.
  44. Singla S, Sachdeva R, Uretsky BF. The risk of adverse cardiac and bleeding events following noncardiac surgery relative to antiplatelet therapy in patients with prior percutaneous coronary intervention. Journal of the American College of Cardiology. 2012;60(20):2005-16.
  45. van Werkum JW, Heestermans AA, Zomer AC, Kelder JC, Suttorp MJ, Rensing BJ, et al. Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. Journal of the American College of Cardiology. 2009;53(16):1399-409.
  46. Ferreira-Gonzalez I, Marsal JR, Ribera A, Permanyer-Miralda G, Garcia-Del Blanco B, Marti G, et al. Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation. Circulation. 2010;122(10):1017-25.
  47. Rajagopalan S, Ford I, Bachoo P, Hillis GS, Croal B, Greaves M, et al. Platelet activation, myocardial ischemic events and postoperative non-response to aspirin in patients undergoing major vascular surgery. Journal of thrombosis and haemostasis : JTH. 2007;5(10):2028-35.
  48. Dedej T, Lamaj E, Marku N, Ostreni V, Bilali S. Alterations in homeostasis after open surgery. A prospective randomized study. G Chir. 2013;34(7-8):202-9.
  49. Chassot PG, Delabays A, Spahn DR. Perioperative use of anti-platelet drugs. Best practice & research Clinical anaesthesiology. 2007;21(2):241-56.
  50. Godier A, Taylor G, Gaussem P. Inefficacy of platelet transfusion to reverse ticagrelor. The New England journal of medicine. 2015;372(2):196-7.
  51. Martin AC, Berndt C, Calmette L, Philip I, Decouture B, Gaussem P, et al. The effectiveness of platelet supplementation for the reversal of ticagrelor-induced inhibition of platelet aggregation: An in-vitro study. European journal of anaesthesiology. 2016;33(5):361-7.
  52. Buchanan A, Newton P, Pehrsson S, Inghardt T, Antonsson T, Svensson P, et al. Structural and functional characterization of a specific antidote for ticagrelor. Blood. 2015;125(22):3484-90.
  53. Manchikanti L, Falco FJ, Benyamin RM, Caraway DL, Kaye AD, Helm S, 2nd, et al. Assessment of bleeding risk of interventional techniques: a best evidence synthesis of practice patterns and perioperative management of anticoagulant and antithrombotic therapy. Pain physician. 2013;16(2 Suppl):Se261-318.
  54. Gulati V, Newman S, Porter KJ, Franco LCS, Wainwright T, Ugoigwe C, et al. Implications of anticoagulant and antiplatelet therapy in patients presenting with hip fractures: a current concepts review. Hip international : the journal of clinical and experimental research on hip pathology and therapy. 2018;28(3):227-33.
  55. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43(3):263-309.
  56. Party: MotW, Harrop-Griffiths W, Cook T, Gill H, Hill D, Ingram M, et al. Regional anaesthesia and patients with abnormalities of coagulation. Anaesthesia. 2013;68(9):966-72.
  57. Anticoagulation Guidelines for Neuraxial Procedures. http://ether.stanford.edu/policies/Anticoagulation_Guidelines_Neuraxial_Procedures.html (2013). Accessed.
  58. Tadros R, Shakib S. Warfarin--indications, risks and drug interactions. Australian family physician. 2010;39(7):476-9.
  59. Cohn MR, Levack AE, Trivedi NN, Villa JC, Wellman DS, Lyden JP, et al. The Hip Fracture Patient on Warfarin: Evaluating Blood Loss and Time to Surgery. Journal of orthopaedic trauma. 2017;31(8):407-13.
  60. Jaffer AK, Brotman DJ, Chukwumerije N. When patients on warfarin need surgery. Cleveland Clinic journal of medicine. 2003;70(11):973-84.
  61. Despotis GJ, Filos KS, Zoys TN, Hogue CW, Jr., Spitznagel E, Lappas DG. Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients. Anesthesia and analgesia. 1996;82(1):13-21.
  62. Spandorfer J. The management of anticoagulation before and after procedures. The Medical clinics of North America. 2001;85(5):1109-16.
  63. Douketis JD. Perioperative anticoagulation management in patients who are receiving oral anticoagulant therapy: a practical guide for clinicians. Thrombosis research. 2002;108(1):3-13.
  64. Bansal R, Watson DK. Surgical delay in acute admissions on warfarin: are we doing enough? International journal of clinical practice. 2005;59(11):1283-8.
  65. Bhatia M, Talawadekar G, Parihar S, Smith A. An audit of the role of vitamin K in the reversal of International Normalised Ratio (INR) in patients undergoing surgery for hip fracture. Annals of the Royal College of Surgeons of England. 2010;92(6):473-6.
  66. Ashouri F, Al-Jundi W, Patel A, Mangwani J. Management of warfarin anticoagulation in patients with fractured neck of femur. ISRN hematology. 2011;2011:294628.
  67. Ranhoff AH, Martinsen MI, Holvik K, Solheim LF. Use of warfarin is associated with delay in surgery for hip fracture in older patients. Hospital practice (1995). 2011;39(1):37-40.
  68. Vitale MA, Vanbeek C, Spivack JH, Cheng B, Geller JA. Pharmacologic reversal of warfarin-associated coagulopathy in geriatric patients with hip fractures: a retrospective study of thromboembolic events, postoperative complications, and time to surgery. Geriatric orthopaedic surgery & rehabilitation. 2011;2(4):128-34.
  69. Leonidou A, Rallan R, Cox N, Pagkalos J, Luscombe J. Comparison of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients. Journal of orthopaedic surgery (Hong Kong). 2013;21(2):142-5.
  70. Tal A, Rubin G, Rozen N. Treatment with vitamin K in hip fracture patients receiving warfarin. The Israel Medical Association journal : IMAJ. 2013;15(7):348-51.
  71. Ahmed I, Khan MA, Nayak V, Mohsen A. An evidence-based warfarin management protocol reduces surgical delay in hip fracture patients. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology. 2014;15(1):21-7.
  72. Buecking B, Eschbach D, Bliemel C, Oberkircher L, Struewer J, Ruchholtz S, et al. Effectiveness of vitamin K in anticoagulation reversal for hip fracture surgery--a prospective observational study. Thrombosis research. 2014;133(1):42-7.
  73. Eardley WG, Macleod KE, Freeman H, Tate A. “Tiers of delay”: warfarin, hip fractures, and target-driven care. Geriatric orthopaedic surgery & rehabilitation. 2014;5(3):103-8.
  74. Gleason LJ, Mendelson DA, Kates SL, Friedman SM. Anticoagulation management in individuals with hip fracture. Journal of the American Geriatrics Society. 2014;62(1):159-64.
  75. Diament M, Eardley WG. An evidence-based warfarin management protocol reduces surgical delay in hip fracture patients. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology. 2015;16(3):263-4.
  76. Moores TS, Beaven A, Cattell AE, Baker C, Roberts PJ. Preoperative warfarin reversal for early hip fracture surgery. Journal of orthopaedic surgery (Hong Kong). 2015;23(1):33-6.
  77. Moores TS, Chatterton BD, Walker MJ. Standardised Warfarin Reversal Expedites Time to Theatre for Fractured Neck of Femur Surgery and Improves Mortality Rates: A Matched Cohort Study. Journal of orthopaedic surgery and research. 2018;2018:4791214.
  78. Mattisson L, Lapidus LJ, Enocson A. Is fast reversal and early surgery (within 24 h) in patients on warfarin medication with trochanteric hip fractures safe? A case-control study. BMC musculoskeletal disorders. 2018;19(1):203.
  79. Tsu LV, Dienes JE, Dager WE. Vitamin K dosing to reverse warfarin based on INR, route of administration, and home warfarin dose in the acute/critical care setting. The Annals of pharmacotherapy. 2012;46(12):1617-26.
  80. Riegert-Johnson DL, Volcheck GW. The incidence of anaphylaxis following intravenous phytonadione (vitamin K1): a 5-year retrospective review. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2002;89(4):400-6.
  81. Rich EC, Drage CW. Severe complications of intravenous phytonadione therapy. Two cases, with one fatality. Postgraduate medicine. 1982;72(5):303-6.
  82. Fiore LD, Scola MA, Cantillon CE, Brophy MT. Anaphylactoid reactions to vitamin K. Journal of thrombosis and thrombolysis. 2001;11(2):175-83.
  83. Shields RC, McBane RD, Kuiper JD, Li H, Heit JA. Efficacy and safety of intravenous phytonadione (vitamin K1) in patients on long-term oral anticoagulant therapy. Mayo Clinic proceedings. 2001;76(3):260-6.
  84. Heit JA. Perioperative management of the chronically anticoagulated patient. Journal of thrombosis and thrombolysis. 2001;12(1):81-7.
  85. Hanley JP. Warfarin reversal. Journal of Clinical Pathology. 2004;57(11):1132-9.
  86. Bux J. Transfusion-related acute lung injury (TRALI): a serious adverse event of blood transfusion. Vox sanguinis. 2005;89(1):1-10.
  87. Sørensen B, Spahn DR, Innerhofer P, Spannagl M, Rossaint R. Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity. Critical Care. 2011;15(1):201.
  88. Combettes E, Mazoit JX, Benhamou D, Beloeil H. Modelling of vitamin K half-life in patients treated with vitamin K antagonists before hip fracture surgery. Anaesthesia, critical care & pain medicine. 2015;34(5):295-9.
  89. Ng R, Shabani-Rad MT. Results of Octaplex for reversal of warfarin anticoagulation in patients with hip fracture. Canadian journal of surgery Journal canadien de chirurgie. 2019;62(1):14-9.
  90. Siegal D, Yudin J, Kaatz S, Douketis JD, Lim W, Spyropoulos AC. Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation. 2012;126(13):1630-9.
  91. Eijgenraam P, ten Cate H, Ten Cate-Hoek A. Safety and efficacy of bridging with low molecular weight heparins: a systematic review and partial meta-analysis. Current pharmaceutical design. 2013;19(22):4014-23.
  92. Schulman S, Hwang HG, Eikelboom JW, Kearon C, Pai M, Delaney J. Loading dose vs. maintenance dose of warfarin for reinitiation after invasive procedures: a randomized trial. Journal of thrombosis and haemostasis : JTH. 2014;12(8):1254-9.
  93. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. The New England journal of medicine. 2009;361(12):1139-51.
  94. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. The New England journal of medicine. 2013;369(22):2093-104.
  95. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. The New England journal of medicine. 2011;365(11):981-92.
  96. Schwarb H, Tsakiris DA. New Direct Oral Anticoagulants (DOAC) and Their Use Today. Dent J (Basel). 2016;4(1):5.
  97. Eliquis 5 mg film-coated tablets. https://www.medicines.org.uk/emc/product/2878/smpc Accessed.
  98. Xarelto 20mg film-coated tablets. https://www.medicines.org.uk/emc/product/2793/smpc (2019). Accessed.
  99. Lixiana 60mg Film-Coated Tablets. https://www.medicines.org.uk/emc/product/6905/smpc (2019). Accessed.
  100. Schermann H, Gurel R, Gold A, Maman E, Dolkart O, Steinberg EL, et al. Safety of urgent hip fracture surgery protocol under influence of direct oral anticoagulation medications. Injury. 2019;50(2):398-402.
  101. Hourston GJ, Barrett MP, Khan WS, Vindlacheruvu M, McDonnell SM. New drug, new problem: do hip fracture patients taking NOACs experience delayed surgery, longer hospital stay, or poorer outcomes? Hip International. 2020; 30(6):799-804.
  102. Mullins B, Akehurst H, Slattery D, Chesser T. Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre. BMJ open. 2018;8(4):e020625..
  103. Franklin NA, Ali AH, Hurley RK, Mir HR, Beltran MJ. Outcomes of Early Surgical Intervention in Geriatric Proximal Femur Fractures Among Patients Receiving Direct Oral Anticoagulation. Journal of orthopaedic trauma. 2018;32(6):269-73.
  104. Lai A, Davidson N, Galloway SW, Thachil J. Perioperative management of patients on new oral anticoagulants. The British journal of surgery. 2014;101(7):742-9.
  105. Kaatz S, Kouides PA, Garcia DA, Spyropolous AC, Crowther M, Douketis JD, et al. Guidance on the emergent reversal of oral thrombin and factor Xa inhibitors. American journal of hematology. 2012;87 Suppl 1:S141-5.
  106. Byron M, Zochert S, Hellwig T, Gavozdea-Barna M, Gulseth MP. Successful use of laboratory monitoring to facilitate an invasive procedure for a patient treated with dabigatran. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2017;74(7):461-5.
  107. Connors JM. Testing and monitoring direct oral anticoagulants. Blood. 2018;132(19):2009-15.
  108. Rottenstreich A, Zacks N, Kleinstern G, Raccah BH, Roth B, Da’as N, Kalish Y. Direct-acting oral anticoagulant drug level monitoring in clinical patient management. Journal of thrombosis and thrombolysis. 2018 May;45(4):543-9.
  109. Pean CA, Goch A, Christiano A, Konda S, Egol K. Current Practices Regarding Perioperative Management of Patients With Fracture on Antiplatelet Therapy: A Survey of Orthopedic Surgeons. Geriatric orthopaedic surgery & rehabilitation. 2015;6(4):289-94.
  110. Palan J, Odutola A, White SP. Is clopidogrel stopped prior to hip fracture surgery--A survey of current practice in the United Kingdom. Injury. 2007;38(11):1279-85.
  111. Inman DS, Michla Y, Partington PF. Perioperative management of trauma patients admitted on clopidogrel (Plavix). A survey of orthopaedic departments across the United Kingdom. Injury. 2007;38(5):625-30.
The Archives of Bone and Joint Surgery
Volume 10, Issue 6
June 2022
Pages 490-500

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History

  • Receive Date: 14 April 2021
  • Revise Date: 26 September 2021
  • Accept Date: 29 September 2021

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