• F Dettoni, F Castoldi, A Giai Via, S Parisi, D E Bonasia, and R Rossi.
• SCDU Ortopedia e Traumatologia, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128, Turin, Italy. federicodettoni@tin.it.
• Eur J Trauma Emerg S. 2011 Oct 1;37(5):511-8.

BackgroundPatients undergoing surgical procedures are usually asked to discontinue any anticoagulant/antiplatelet therapy and delay surgery for at least 5 days to reduce the risk of major bleeding and spinal hematoma.AimThe purpose of this study was to determine if this strategy is suitable for patients on anticoagulant/antiplatelet therapy affected by a hip fracture, evaluating the effect of anticoagulant/antiplatelet therapy and surgical timing on mortality and complication rates for patients affected by a hip fracture.Patients And MethodsWe performed an observational study on patients referring to our hospital for a hip fracture. We evaluated patients on warfarin, ticlopidine, and aspirin therapy matched to patients not on anticoagulant or antiplatelet therapy, out of 875 consecutive patients treated for a hip fracture in a 5-year period. Blood loss, blood transfusions, length of hospitalization, walking ability, complications, and mortality at 1 year of follow-up were recorded. Kruskal-Wallis, Mann-Whitney U, and logistic regression statistical tests were performed.ResultsPatients on warfarin therapy operated more than 5 days after admission showed significantly higher complication and mortality rates compared to all other patients. Two critical factors were identified: warfarin therapy and excessive time to surgery; these factors are not significant if taken alone, while they become a high-risk factor if taken together.ConclusionThe "discontinue drug, and delay surgery" strategy is not suitable for patients on anticoagulant (warfarin) therapy affected by a hip fracture.

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