Objective: 

To evaluate the effect of warfarin on blood transfusion and postoperative complications in a low-energy hip fracture population compared with a non-anticoagulated comparison group.

Design: 

Multicenter Retrospective Cohort.

Setting: 

Three Urban Level I Academic Trauma Centers.

Patients: 

Acute, low-energy, native hip fractures in patients 55 years of age or older on chronic warfarin anticoagulation, propensity score matched 1:2 to non-anticoagulated hip fracture patients meeting all other inclusion criteria.

Main Outcome Measurements: 

Transfusion and postoperative complication rates.

Results: 

Two hundred ten anticoagulated hip fracture patients were matched to 420 nonanticoagulated patients. A higher proportion of patients required blood transfusion in the warfarin cohort (52.4% vs. 43.3%, P < 0.001), attributable mostly to the subgroup of patients undergoing arthroplasty. Warfarin patients had higher incidence of overall 90-day complications (47% vs. 38%, P = 0.039) and readmissions (31.4% vs. 8.9%, P < 0.001). Day of surgery international normalized ratio (INR) did not influence transfusions or complications among warfarin patients. Warfarin patients undergoing surgery within 24 hours had no difference in transfusions and had fewer complications compared with those undergoing surgery after 24 hours. On multivariable logistic regression analysis, warfarin use and day of surgery INR were not predictors of transfusion or complications.

Conclusions: 

Patients on warfarin experienced longer time to surgery and higher incidence of overall transfusion and postoperative complications within 90 days of surgery. However, warfarin use and day of surgery INR was not independently associated with transfusions or complications. The reason for poorer outcomes in warfarin patients remains a topic of further investigation.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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髋部骨折患者慢性华法林抗凝治疗会延迟手术并与术后并发症风险增加相关：多中心倾向评分匹配分析

 客观的：

与非抗凝对照组相比，评估华法林对低能量髋部骨折人群输血和术后并发症的影响。

 设计：

多中心回顾性队列。

 环境：

三个城市一级学术创伤中心。

 患者：

55 岁或以上接受长期华法林抗凝治疗的患者发生急性、低能量、原生髋部骨折，倾向评分与符合所有其他纳入标准的非抗凝髋部骨折患者按 1:2 匹配。

主要结果测量：

输血和术后并发症发生率。

 结果：

200 名接受抗凝治疗的髋部骨折患者与 420 名未接受抗凝治疗的患者进行了匹配。华法林队列中需要输血的患者比例较高（52.4% vs. 43.3%， P < 0.001），这主要归因于接受关节置换术的患者亚组。华法林患者的总体 90 天并发症发生率较高（47% vs. 38%， P = 0.039）和再入院率较高（31.4% vs. 8.9%， P < 0.001）。手术当天国际标准化比值（INR）不影响华法林患者的输血或并发症。 24小时内接受华法林手术的患者与24小时后接受手术的患者相比，输血没有差异，并发症也较少。在多变量逻辑回归分析中，华法林的使用和手术日期 INR 并不是输血或并发症的预测因素。

 结论：

服用华法林的患者手术时间较长，术后 90 天内整体输血和术后并发症的发生率较高。然而，华法林的使用和手术当天的 INR 与输血或并发症并不独立相关。华法林患者预后较差的原因仍然是进一步研究的主题。

 证据级别：

治疗三级。有关证据级别的完整描述，请参阅作者须知。