Effect of reversal of warfarin with concentrate of coagulating factors II, VII, IX, X on shortening of the time to surgery interval, morbidity, and mortality in chronic anticoagulated patients with proximal femur fracture
Abstract
Introduction: Fractures of the proximal part of femur belong to the most frequent fractures worldwide. It is supposed that the time to surgery is one of the influencing factors of the mortality and morbidity.
The aim of this study was to determine whether shortening of preoperative preparation of patients chronically treated with warfarin and indicated for acute surgical procedure by administration of concentrate of the plasmatic coagulation factors leads to the influence on postoperative morbidity and mortality. Methods: Patients chronically on warfarin indicated for surgical repair of the fractures of proximal part of the femoral bone were included in the study.
Group A included patients waiting for the emergency surgery and prepared with application of fresh frozen plasma and vitamin K. Group B included patients who received prothrombin complex concentrates before the procedure.
Evaluated parameters were: clinical parameters, length of hospital stay (LOS) and overall mortality rate, complication rate, laboratory parameters. Results: We were able to demonstrate in this study that reversal of the effect of warfarin with a concentrate of prothrombin complex factors led to more rapid normalization of INR, and thus to an earlier start of surgery, compared with the reversal of warfarin only with administration of fresh frozen plasma and vitamin K.
We were also able to demonstrate that reversal of warfarin effect with fresh frozen plasma leads to a worse normalization of the INR than administration of the prothrombin complex concentrate factors. The study results did not show that reducing pre-operative preparation time with concentrate of prothrombin complex factors resulted in the reduced morbidity represented by the length of hospital stay.
Conclusions: Reversal of patients on warfarin with prothrombin complex factors complex does not influence the postoperative morbidity and mortality. However, we demonstrated its better prothrombin efficiency compared with the effect of fresh frozen plasma.