title: An evidence-based warfarin management protocol reduces surgical delay in hip fracture patients.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level III.
authors.affiliation: Department of Anaesthesia and Critical Care, Hull Royal Infirmary, Anlaby Road, Kingston upon Hull, HU3 2JZ, UK, driftikhar64@doctors.org.uk.
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.forename: V
authors.initials: V
authors.lastname: Nayak
authors.forename: A
authors.initials: A
authors.lastname: Mohsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D059035:Perioperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014812:Vitamin K / Q000008:administration & dosage*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D014812:Vitamin K; D014859:Warfarin