title: Effectiveness of vitamin K in anticoagulation reversal for hip fracture surgery--a prospective observational study.
abstract: BACKGROUND
  Vitamin K antagonists are often used for anticoagulant treatment in hip fracture patients. The optimal handling with such anticoagulants is unclear. We aimed to determine when anticoagulation reversal occurred after vitamin K administration and how often prothrombin complex concentrates (PCCs) were administered. We compared patients' treatments and outcomes with those of a control group not receiving treatment for anticoagulation.
  
  
  METHODS
  A total of 402 geriatric hip fracture patients were included in this observational study. We collected data on treatment for anticoagulation, time to surgery, and reasons for delay of surgery. In patients taking vitamin K antagonists, we measured the INR (international normalized ratio) on admission and prior to surgery, along with the frequency of PCC administration. Finally, we compared in-hospital mortality and complications between patient groups.
  
  
  RESULTS
  A total of 62 (15%) patients received phenprocoumon prior to their fractures. Surgery was delayed in these patients compared to controls (27h; 95%CI 23-31 vs. 16h; 95%CI 19-19; p=0.001), but surgery delay >48h (n=5; 8%) was not due to a failure of INR reversal. The main reason for these delays was a lack of capacity for surgery. The average INR on admission was 2.1 (±0.7; range 1.0-3.5) in patients taking phenprocoumon, which decreased to 1.3 (±0.3; range 1.0-1.6) until surgery. PCCs were administered to 19% of patients. We found no differences in the in-hospital mortality (6.2% vs. 8.1%, p=0.575) or complication rates (12.9% vs. 9.4%, p=0.364).
  
  
  CONCLUSIONS
  The use of vitamin K seemed to be sufficient for anticoagulation reversal in geriatric hip fracture patients, and it generally led to timely surgery; despite this success, PCCs were sometimes administered for logistical reasons.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Campus Marburg. Electronic address: buecking@med.uni-marburg.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Buecking
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Campus Marburg.
authors.forename: Daphne
authors.initials: D
authors.lastname: Eschbach
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Campus Marburg.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bliemel
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Campus Marburg.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Oberkircher
authors.affiliation: Department of Orthopaedics and Rheumatology, University of Giessen and Marburg, Campus Marburg.
authors.forename: Johannes
authors.initials: J
authors.lastname: Struewer
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Campus Marburg.
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.affiliation: Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany; Center for Transfusion Medicine and Hemotherapy, University Hospital Giessen and Marburg, Campus Marburg.
authors.forename: Ulrich J
authors.initials: UJ
authors.lastname: Sachs
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D016022:Case-Control Studies; D005260:Female; D006620:Hip Fractures / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D010644:Phenprocoumon / Q000008:administration & dosage*; D011446:Prospective Studies; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D010644:Phenprocoumon
keywords: Anticoagulation; Blood management; Complication; Hip fracture; Vitamin K antagonist