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

Abstract

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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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