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Lookup NU author(s): Syed Mannan, Jessie Jeyapalan, Sarah Johnson-Lynn, Chryssa Neo, Steven Borland, Shiv Kolhe, Dr Andreas Panagiotopoulos
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© 2024 The Author(s)Introduction: Approximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist. Some hospitals employ dedicated anticoagulation management protocols to address this issue, and to improve time to surgery. This study aimed to determine the proportion of hospitals with such protocols, compare protocol guidance between hospitals, and evaluate the effectiveness of protocols in facilitating prompt surgery. Methods: Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the UK. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Information from dedicated anticoagulation management protocols were collated on several domains relating to perioperative care including administration of reversal agents and instructions on timing of surgery as well as others. Logistic regression was used to evaluate effects of dedicated protocols on time to surgery. Results: Dedicated protocols for management of patients taking warfarin and DOACs were present at 41 (52.6 %) and 43 (55.1 %) hospitals respectively. For patients taking warfarin, 39/41 (95.1 %) protocols specified the dose of vitamin k and the most common was 5 milligrams intravenously (n=21). INR threshold values for proceeding to surgery varied between protocols; 1.5 (n=28), 1.8 (n=6), and 2 (n=6). For patients taking DOACs, 35/43 (81.4 %) and 8/43 (18.6 %) protocols advised timing of surgery based on renal function and absolute time from last dose respectively. Analysis of 10,197 patients from 78 hospitals showed fewer patients taking DOACs received surgery within 36 h of admission at hospitals with a dedicated protocol compared to those without (adjusted OR 0.73, 95% CI 0.54–0.99, p=0.040), while there were no differences among patients taking warfarin (adjusted OR 1.64, 95% CI 0.75–3.57, p=0.219). Conclusions: Around half of hospitals employed a dedicated anticoagulation management protocol for femoral fragility fracture patients, and substantial variation was observed in guidance between protocols. Dedicated protocols currently being used at hospitals were ineffective at improving the defined targets for time to surgery.
Author(s): Farhan-Alanie MM, Dixon J, Irvine S, Walker R, Eardley WGP, Smith M, Yoong A, Lim JW, Yousef O, McDonald S, Chileshe C, Ramus C, Clements C, Barrett L, Rockall O, Geetala R, Islam SU, Nasar A, Almond K, Hassan LFY, Shah S, Brand RB, Yawar B, Gilmore C, McAuley D, Khan W, Subramanian P, Ahluwalia A, Ozbek L, Awasthi P, Sheikh H, Barkley S, Ardolino T, Denning A, Thiruchandran G, Fraig H, Salim O, Iqbal R, Guy S, Hogg J, Bagshaw O, Asmar S, Mitchell S, Quek F, Fletcher J, French J, Graham S, Sloper P, Sadique H, Matera V, Sohail Z, Leong JW, Issa F, Greasley L, Marsden S, Parry L, Mannan S, Zaheen H, Moriarty P, Manning W, Morris T, Brockbanks C, Ward P, Pearce K, McMenemy L, Mahmoud M, Kieffer W, Lal A, Collis J, Chandrasekaran K, Foxall-Smith M, Raad M, Kempshall P, Cheuk J, Leckey S, Gupta R, Engelke D, Kemp M, Venkatesan A, Hussain A, Simons M, Raghavendra RM, Rohra S, Deo S, Vasarhelyi F, Thelwall C, Cullen K, Al-Obaidi B, Fell A, Thaumeen A, Dadabhoy M, Ali M, Ijaz S, Lin D, Khan B, Alsonbaty M, Lebe M, Millan RK, Imam S, Theobald E, Cormack J, Sharoff L, Eardley W, Jeyapalan R, Alcock L, Clayton J, Bates N, Mahmoud Y, Osborne A, Ralhan S, Carpenter C, Ahmad M, Ravi SM, Konbaz T, Lloyd T, Sheikh N, Swealem A, Soroya E, Rayan F, Ward T, Vasireddy A, Clarke E, Sikdar O, Smart YW, Windley J, Ilagan B, Brophy E, Joseph S, Lowery K, Jamjoom A, Ismayl G, Aujla R, Sambhwani S, Ramasamy A, Khalaf A, Ponugoti N, Teng WH, Masud S, Otoibhili E, Clarkson M, Nafea M, Sarhan M, Hanna S, Kelly A, Curtis A, Gourbault L, Tarhini M, Platt N, Fleming T, Pemmaraju G, Choudri MJ, Burahee A, Hassan L, Hamid L, Loveday D, Edres K, Schankat K, Granger L, Goodbun M, Parikh S, Johnson-Lynn S, Griffiths A, Rai A, Chandler H, Guiot L, Appleyard T, Robinson K, Fong A, Watts A, Stedman T, Walton V, Inman D, Liaw F, Hadfield J, McGovern J, Baldock T, White J, Seah M, Jacob N, Ali ZH, Goff T, Sanalla A, Gomati A, Nordin L, Hassan E, Ramadan O, Teoh KH, Baskaran D, Ngwayi J, Abbakr L, Blackmore N, Mansukhani S, Guryel E, Harper A, Cashman E, Brooker J, Pack L, Regan N, Wagner W, Selim A, Archer D, McConaghie G, Patel R, Gibson W, Pasapula CS, Youssef H, Aziz MA, Subhash S, Banaszkiewicz P, Elzawahry A, Neo C, Wei N, Bhaskaran A, Sharma A, Factor D, Shahin F, Shields D, Ferreira CDF, Jeyakumar G, Liao Q, Sinnerton R, Ashwood N, Sarhan I, Ker A, Phelan S, Paxton J, McAuley J, Moulton L, Mohamed A, Dias A, Ho B, Francis D, Miller S, Phillips J, Jones R, Arthur C, Oag E, Thutoetsile K, Bell K, Milne K, Whitefield R, Patel K, Singh A, Morris G, Parkinson D, Patil A, Hamid H, Syam K, Singh R, Menon D, Crooks S, Borland S, Rohman A, Nicholson A, Smith B, Hafiz N, Kolhe S, Waites M, Piper D, Westacott D, Grimshaw J, Bott A, Berry A, Battle J, Flannery O, Iyengar KP, Thakur AW, Yousef M, Bansod V, El-nahas W, Dawe E, Oladeji E, Federer S, Trompeter A, Pritchard A, Shurovi B, Jordan C, Little M, Sivaloganathan S, Shaunak S, Watters H, Luck J, Zbaeda M, Frasquet-Garcia A, Warner C, Telford J, Rooney J, Attwood J, Wilson F, Panagiotopoulos A, Keane C, Scott H, Mazel R, Maggs J, Skinner E, McMunn F, Lau J, Ravikumar K, Thakker D, Gill M, McCarthy P, Fossey G, Shah S, McAlinden G, McGoldrick P, O'Brien S, Patil S, Millington A, Umar H, Sehdev S, Dyer-Hill T, Yu Kwan T, Tanagho A, Hagnasir A, White T, Bano C, Kissin E, Ghani R, Thomas PSW, McMullan M, Walmsley M, Elgendy M, Winstanley R, Round J, Baxter M, Thompson E, Hogan K, Youssef K, Fetouh S, Hopper GP, Simpson C, Warren C, Waugh D, Nair G, Ballantyne A, Blacklock C, O'Connell C, Toland G, McIntyre J, Ross L, Badge R, Loganathan D, Turner I, Ball M, Maqsood S, Deierl K, Beer A, Tan ACW, Mackinnon T, Gade V, Gill J, Yu San K, Archunan MW, Shaikh M, Ugbah O, Uwaoma S, Pillai A, Nath U, Rohan
Publication type: Article
Publication status: Published
Journal: Injury
Year: 2024
Volume: 55
Issue: 8
Print publication date: 01/08/2024
Online publication date: 19/06/2024
Acceptance date: 17/06/2024
ISSN (print): 0020-1383
ISSN (electronic): 1879-0267
Publisher: Elsevier Ltd
URL: https://doi.org/10.1016/j.injury.2024.111686
DOI: 10.1016/j.injury.2024.111686
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