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Jay-Caillierez L, Friggeri A, Viste A, Lefevre M, Decullier E, Bernard L, Piriou V, David JS. Safety and efficacy of a strategy of vitamin K antagonist reversal with prothrombin complex concentrates compared to vitamin K in patients with hip fracture. Can J Surg 2021; 64:E330-E338. [PMID: 34085510 PMCID: PMC8327982 DOI: 10.1503/cjs.002120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Increased preoperative delay in patients with hip fractures may be responsible for increased morbidity and mortality. We hypothesized that a strategy of reversal of vitamin K antagonist (VKA) by prothrombin complexes concentrates (PCCs), as compared to vitamin K, is safe and reduces preoperative delay and hospital length of stay (LOS). Methods: In this pilot study, we reviewed the records of patients admitted to a university-affiliated hospital for hip fracture between Jan. 1, 2012, and Dec. 31, 2016, who were taking VKA. Patients were stratified according to reversal strategy (vitamin K v. PCC). Adverse effects, time to surgery, LOS and mortality were collected from the electronic medical record and were compared between the 2 study groups and a control group not treated with VKA. Results: A total of 141 patients were included in the study: 65 in the vitamin K group, 26 in the PCC group and 50 in the control group. The median preoperative delay in the PCC group (20 h [interquartile range (IQR)] 13–25 h]) and the control group (20 h [IQR 15–33 h]) was lower than that in the vitamin K group (45 h [IQR 31–52 h]) (p < 0.001). Patients in the PCC group had a shorter median hospital LOS than those in the vitamin K group (6 d [IQR 4–9 d] v. 8 d [IQR 6–11 d], p < 0.05). No difference was observed in the proportion of patients who received a red blood cell transfusion, or had thrombotic or hemorrhagic complications. No difference in mortality at 12 months was observed between the groups. Conclusion: In patients with hip fracture, the use of PCCs as compared to vitamin K to reverse the effect of VKA significantly reduced preoperative delay and hospital LOS, and was not associated with an increase in the rates of thrombotic or hemorrhagic complications. Prospective studies involving a greater number of patients are required to confirm these promising results.
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Affiliation(s)
- Lucille Jay-Caillierez
- From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David)
| | - Arnaud Friggeri
- From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David)
| | - Anthony Viste
- From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David)
| | - Mathilde Lefevre
- From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David)
| | - Evelyne Decullier
- From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David)
| | - Lorraine Bernard
- From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David)
| | - Vincent Piriou
- From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David)
| | - Jean-Stéphane David
- From the Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Jay-Caillierez, Friggeri, Lefevre, Piriou, David); the Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France (Decullier, Lorraine); the EA Santé Individu Société, Université Claude Bernard Lyon 1, Lyon, France (Decullier, Bernard); the Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France (Viste); IFSTTAR, UMR-T9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France (Viste); and the Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France (Friggeri, Viste, Piriou, David)
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