title: Warfarinized Patients with Proximal Femoral Fractures: Survey of UK Clinical Practice.
abstract: BACKGROUND
  In an aging population, anticoagulation in patients with musculoskeletal injuries is increasingly prevalent. The North American literature indicates an absence of consensus concerning the most appropriate management for this group. We aim to test the hypothesis that there is a lack of consensus in the UK regarding the perioperative management of patients with hip fractures on long-term warfarin therapy.
  
  
  METHODS
  A representative group of 400 consultant orthopedic surgeons was surveyed by postal questionnaire regarding their policy on the reversal of anticoagulation in warfarinized patients with hip fractures. The consultants contacted were selected to represent a geographical spread throughout the UK.
  
  
  RESULTS
  There were 159 respondents (40% response rate), of which 79% (126) had a trauma commitment. 95 (75%) of these had a protocol for the reversal of anticoagulation prior to surgery. The commonest method used was to simply withhold warfarin and wait (70%). Other methods included FFP (16%), and low-dose (23%) and high-dose (14%) vitamin K. Some respondents used more than onemethod. Although nearly all respondents preferred an INR < 2.0 prior to surgery, 55% preferred an INR < 1.5.
  
  
  CONCLUSIONS
  Hip fracture in the presence of long-term warfarin use is associated with significantly increased morbidity. This problem is likely to increase. Our results demonstrate variation in approach throughout the UK with regard to warfarin reversal and the acceptable INR at which to operate in this group of patients. We propose that low-dose vitamin K is considered more widely as a safe and effective method of warfarin reversal in this group.
authors.affiliation: Department of Arthroplasty, Robert Jones and Agnes Hunt Orthopedic Hospital, Gobowen, UK. ianstarks@doctors.org.uk.|Department of Arthroplasty, Robert Jones and Agnes Hunt Orthopedic Hospital, Gobowen, UK. ianstarks@doctors.org.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Starks
authors.affiliation: Department of Childrens Orthopedics, Robert Jones and Agnes Hunt Orthopedic Hospital, Gobowen, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Cooke
authors.affiliation: Department of Trauma and Orthopedics, Worcestershire Acute Hospitals NHS Trust, Worcester Royal Infirmary, Worcester, Worcestershire, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Docker
authors.affiliation: Department of Trauma and Orthopedics, Staffordshire General Hospital, Stafford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Raine
keywords: Hip fracture; International normalized ratio; Vitamin K; Warfarin
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