Perioperative management of the patients with hip fracture under anticoagulant or antiaggregants treatment. Consensus recommendations from the hemostasis section of SEDAR

Abstract

Background: Antiaggregant and anticoagulant therapy complicate the management of patients with osteoporotic hip fracture.

Objective: To homogenize and improve daily clinical practice with simple recommendations.

Methods: The haemostasis section of SEDAR established a working group to define an action plan for the management of antiaggregated or anticoagulated patients with an osteoporotic hip fracture. The suggested recommendations are based on evidence of best practices, and have been validated by a multidisciplinary group formed by 6 specialties.

Results: Early surgery reduces complications and mortality and improves patient comfort and functional recovery, with no difference in mortality between intradural and general anaesthesia.

Conclusion: Although uncertainties remain, it is recommended to perform surgery within 24-48 h of admission, adapting peripheral nerve blocks and type of anaesthesia (neuraxial or general) an to the haemostatic conditions. A multimodal management of antithrombotics, and the optimisation of haemostasis, haemoglobin and venous thromboprophylaxis since admission are suggested.

Keywords: Anaesthesia; Anestesia; Anticoagulación; Anticoagulation; Bloqueo nervioso; Fractura de cadera; Hip fracture; Nervous block; Thromboprophylaxis; Transfusión; Tromboprofilaxis.