The Effect of Long-Term Antithrombotic Therapies on Perioperative Morbidity and Mortality in Elderly Patients Underwent Hip Fracture Surgery Kalça Kırığı Cerrahisi Geçiren Yaşlı Hastalarda Uzun Dönem Antitrombotik Tedavilerin Perioperatif Morbidite ve Mortalite Üzerine Etkisi
Genel Tip Dergisi, cilt.32, sa.3, ss.229-237, 2022 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 32 Sayı: 3
- Basım Tarihi: 2022
- Doi Numarası: 10.54005/geneltip.1097997
- Dergi Adı: Genel Tip Dergisi
- Derginin Tarandığı İndeksler: Scopus, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.229-237
- Anahtar Kelimeler: Dual antiplatelets, elderly patient, hip fracture, novel oral anticoagulants, warfarin
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
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 underwent 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), and 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 hemoglobin (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 as the nonuser group (p<0.05). In terms of survival, multivariate analysis showed no difference between the groups (p>0.05). However survival was statistically significantly 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 period than patients in the group warfarin, group NOACs, and 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.