抗凝股骨脆性骨折患者的管理。

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI:10.1177/11207000241282303
Muhamed M Farhan-Alanie, William G P Eardley
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引用次数: 0

摘要

约20%的股骨脆性骨折患者使用抗凝剂,超过30%的患者使用抗血小板药物,这两种药物都可能导致手术延迟。以前只限于股骨近端骨折,现在对老年患者的所有股骨骨折,包括涉及植入物的骨折,都要进行性能评估、结果和手术延迟评估。本叙述性综述汇集了与股骨骨折老年患者抗凝和抗血小板治疗相关的所有文献,主要涉及5个关键点:抗凝和抗血小板使用的普遍性;治疗方案分析;国家指南整理;围术期管理比较;手术时机和围术期结果。我们的研究发现,股骨脆性骨折患者服用抗凝剂和抗血小板药物的比例分别为20%-40%和25%-35%。与维生素K拮抗剂相比,更多的抗凝患者服用直接口服抗凝剂,这对实践中的差异和手术延迟产生了越来越大的影响。目前已有一些国家指导方针,但这些指导方针的特点是差异明显,几乎没有标准化,而且没有任何指导方针适用于所有股骨脆性骨折。服用抗凝剂或抗血小板药物的患者在入院后36小时内接受快速手术是安全的,在许多小样本研究中,股骨近端骨折的患者都证实了这一点,但股骨非近端骨折的患者尽管具有相似的特征,却没有此类证据。在研究和评估老年人群的治疗效果时,有必要考虑到老年人的所有股骨骨折,以避免不必要的差异和延误。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The management of anticoagulated fragility femoral fracture patients.

Approximately 20% of patients sustaining a fragility femur fracture use an anticoagulant, and over 30% use an antiplatelet medication, both of which can result in surgical delay. Previously confined to fractures of the proximal femur, performance assessment, outcome and surgical delay is now assessed for all fractures of the femur in older patients, including those involving implants. This narrative review draws together all literature pertaining to anticoagulation and antiplatelet management in older patients with a fracture of the femur to address 5 key points: prevalence of anticoagulant and antiplatelet use; analysis of management protocols; collation of national guidelines; comparison of perioperative management; timing of surgery and perioperative outcomes.Our review found that the prevalence of fragility femur fracture patients taking anticoagulant and antiplatelet medication ranges from 20-40% and 25-35% respectively. More anticoagulated patients are taking direct oral anticoagulants compared to vitamin k antagonists with growing implications for variation in practice and delays to surgery.Several national guidelines exist although these are characterised by marked variation, there is little standardisation, and none are generalised across all fragility femur fractures.Expedited surgery within 36 hours of admission in patients taking an anticoagulant or antiplatelet medication is safe and has been demonstrated in fractures of the proximal femur across many small number studies although no such evidence exists in non-proximal femur fractures despite this population sharing similar characteristics. There is a need for all fractures of the femur in older people to be considered when researching and assessing performance in this population to prevent needless variation and delay.

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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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