The effect of long-term antithrombotic therapies on perioperative morbidity and mortality in elderly patients undergoing hip fracture surgery

Year 2022, , 229 - 237, 01.08.2022

Güzin Ceran , Ayşe Lafçı , İsmail Aytaç , Gazi Akkurt , Nermin Göğüş , Derya Gokcinar

https://doi.org/10.54005/geneltip.1097997

Abstract

ABSTRACT
Objective: Ischemic complications or massive bleeding are important perioperative complications in elderly patients using antithrombotic drugs. The need for blood product replacement, transfusion-related complications, prolonged stay in hospital and intensive care unit, and high mortality in the perioperative period can be seen. The aim of this study was to investigate the effects of long-term different antithrombotic therapies on morbidity and mortality in elderly patients undergoing surgery for hip fracture.
Materials and Methods: This retrospective cohort study included patients aged 65 years and older who underwent surgery for hip fracture between 2015 and 2018. Patients with no antithrombotic treatment (Group NonAT), warfarin (Group Warfarin), novel oral anticoagulants (Group NOACs), or dual antiplatelet therapy (Group DAPT) were compared in terms of major bleeding, deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) complications, length of hospital stay (LOS), ICU admission, and 30-day mortality.
Results: The study included 668 patients; demographic data in Group NonAT (n=442), Group Warfarin (n=59), Group NOACs (n=30) and Group DAPT(n=137) were similar. Major bleeding and red blood cell transfusion did not differ statistically between all groups. (p>0.05) The preoperative and postoperative Hb values of the patients were not statistically different between the groups (p>0.05). Mortality, only there was statistically significantly higher in the dual antiplatelet group than the non user group. (p<0.05) In terms of survival, multivariate analysis showed no difference between the groups. (p>0.05) However survival was statistically significant different (p<0.05) in terms of the PTE and admission to ICU. Kaplan-Meier survival analysis showed that patients in the group NonAT have longer survival times than patients in the group warfarin, group NOACs, or group DAPT.
Conclusion: In this study, we found that the effects of antithrombotic drug classes (warfarin, new oral anticoagulants or dual antiplatelet therapy) on mortality were not different. Mortality rate was higher only in the dual antiplatelet group than in the no drug group. It is important to discontinue these drugs at the timing according to their half-lives and elimination times. Effective bridging therapy should be applied in the perioperative period. Thus, the risk of major bleeding or complications of DVT and PTE can be avoided. New bridging strategies should be researched in patients using antiplatelets.

Keywords

Hip fracture, elderly patient, warfarin, novel oral anticoagulants, dual antiplatelets

Kalça kırığı cerrahisi geçiren yaşlı hastalarda uzun dönem antitrombotik tedavilerin perioperatif morbidite ve mortalite üzerine etkisi

Abstract

Amaç: Antitrombotik ilaç kullanan yaşlı hastalarda, iskemik komplikasyonlar veya masif kanama önemli perioperatif komplikasyonlardır. Kan ürünü replasmanı ihtiyacı, transfüzyona bağlı komplikasyonlar, hastanede ve yoğun bakımda kalış süresinin uzaması ve perioperatif dönemde yüksek mortalite görülebilmektedir. Bu çalışmanın amacı, kalça kırığı nedeniyle ameliyat edilen yaşlı hastalarda uzun süreli farklı antitrombotik tedavilerin morbidite ve mortalite üzerine etkilerini araştırmaktır.
Gereç ve Yöntem: Bu retrospektif kohort çalışmasına 2015 ve 2018 yılları arasında kalça kırığı nedeniyle ameliyat edilen 65 yaş ve üstü hastalar dahil edilmiştir. Antitrombotik tedavi almayan hastalar (Grup NonAT), varfarin (Grup Warfarin), yeni oral antikoagülanlar (Grup NOAC'ler) veya ikili antiplatelet tedavi (Grup DAPT) alan hasta grupları majör kanama, derin ven trombozu (DVT) ve pulmoner tromboembolizm (PTE) komplikasyonları, hastanede kalış süresi (LOS), yoğun bakım ünitesine yatış ve 30 günlük mortalite açısından karşılaştırıldı.
Bulgular: Çalışmaya 668 hasta dahil edildi; Grup NonAT(n=442), Grup Warfarin (n=59), Grup NOACs (n=30) ve Grup DAPT(n=137) hasta demografik verileri benzerdi. Majör kanama ve kırmızı kan hücresi transfüzyonu tüm gruplar arasında istatistiksel olarak fark yoktu. (p>0.05) Hastaların ameliyat öncesi ve sonrası Hb değerleri gruplar arasında istatistiksel olarak farklı değildi (p>0.05). Ölüm oranı, sadece ikili antiplatelet grubunda, hiç ilaç kullanmayan gruba göre istatistiksel olarak anlamlı derecede yüksekti. (p<0.05) Sağkalım açısından multivariate analysis gruplar arasında fark göstermedi. (p>0.05) Ancak sağ kalım PTE ve YBÜ'ye yatış açısından istatistiksel olarak anlamlı farklılık gösterdi (p<0.05). Kaplan-Meier yaşam analizi, NonAT grubundaki hastaların varfarin, grup NOACs veya grup DAPT'deki hastalardan daha uzun hayatta kalma sürelerine sahip olduğunu gösterdi.
Sonuç: Bu çalışmada, antitrombotik ilaç sınıflarının (varfarin, yeni oral antikoagülanlar veya ikili antiplatelet tedavi) mortalite üzerindeki etkilerinin farklı olmadığını bulduk. Ölüm oranı, sadece ikili antiplatelet grubunda, hiç ilaç kullanmayan gruba göre daha yüksekti. Bu ilaçların yarılanma ömürlerine ve eliminasyon sürelerine göre preoperatif kesilmesi önemlidir. Perioperatif dönemde etkin köprüleme tedavisi uygulanmalıdır. Böylece majör kanama veya DVT ve PTE komplikasyonları riskinden kaçınılabilir. Antiplatelet kullanan hastalarda yeni köprüleme stratejileri araştırılmalıdır.

Keywords

Kalça kırığı, yaşlı hasta, warfarin, yeni oral antikoagülanlar, dual antiplateletler

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