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#36517 Perioperative management of antithrombotic therapy in hip fracture surgery
  1. Amparo Izquierdo Aicart,
  2. Maria Sempere,
  3. Alba Montoya and
  4. Rafael Badenes
  1. Anesthesiology, Hospital Clínic Universitari de València, Valencia, Spain


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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims Hip fracture surgery has a huge prevalence and morbimortality. One of the main reasons of delaying surgery is the use of anticoagulants/antiplatelet therapies, being these patients old and with comorbidities. Risks of delay surgery are higher than surgical bleeding or vertebral canal haematoma; so promp surgery in first 48 hours should be facilitated.

Methods In this review we search the main guidelines about perioperative management of antithrombotic drugs and locorregional guidelines; focusing in hip fracture surgery and also its management when neuroaxial anesthesia is performed.

Results -With antiplatelet drugs therapy surgery should not be delay. In case of PY12 inhibitors neuraxial anesthesia is not recommended. -With vitamin K antagonists therapy, reversal with vitamin K/prothrombin complex concentrate (PCC) should be done for ensure INR <1,8. Neuraxial anesthesia can be performed when INR <1,5. -With new oral anticoagulants (NOAC) interruption intervals of 1-2 half-life is recommended (12-24 hours without impaired kidney function). Neuraxial anesthesia is not recommended in early surgery without a specific coagulation test. If there is a risk performing general anesthesia we should consider use of reversal agents or specific tests.

Abstract #36517 Table 1

Perioperative management of main antithrombotic drugs in hip fracture surgery

Conclusions Early hip fracture surgery is safe in patients taking anticoagulant/antiplatelet drugs. Special attention should we pay in perioperative timing when neuraxial anesthesia is performed.

  • antithrombotic agents
  • hip fracture surgery
  • perioperative management
  • regional anesthesia

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