How should we manage hip fracture patients on direct oral anticoagulants?

ObjectiveCurrently, there are no national protocols in place for managing hip fracture patients on direct oral anticoagulants (DOACs). Hence, various local management protocols exist. We compared three different local protocols and a control group to assess blood loss and time delay to theatre.MethodsSequential data were collected for 120 hip fracture patients in four groups; wait 24 hours from last dose, wait 48 hours, perform DOAC levels and control.ResultsDOAC use in our hip fracture patients was 14%. Median haemoglobin (Hb) drop between the three protocol groups showed no significant difference (13.5, 21.5 and 16.0 g/L) (Kruskal-Wallis, p=0.9). Median Hb drop in the control group was 16.0 g/L versus 17.5 g/L in the protocol groups combined (Mann Whitney-U, p=0.7). Average Hb drop in the control group was 19.2 g/L and in the protocol groups was 22.1 g/L; a 15% greater blood loss with DOACs. The frequency distribution of blood loss was different between the control and protocol groups, but not between the protocol groups. The highest Hb drop in the control group was 3.4 g/L, while in the protocol groups, it was 7.8 g/L. Median Hb on arrival to hospital was higher in the control group (124 g/L) compared with the three protocol groups (87 g/L) (t-test p<0.0001). Transfusion rates of up to 40% were observed within the DOAC groups compared with zero in the control group.Median time to theatre between the three protocol groups was significantly different at 17.5, 53.3 and 22.5 hours, respectively (Kruskal-Wallis, p<0.0001).ConclusionDOACs caused increased bleeding and delays to theatre in hip fracture patients, however the largest Hb difference was already apparent on arrival. Subsequent blood loss was minimal on average; a few patients bled heavily. Prolonged waiting made no significant difference to blood loss, but caused delay to theatre leading to financial losses from best practice tariff.

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The Efficacy of Intravenous Tranexamic Acid in Reduction of Blood Loss in Women at High Risk of Postpartum Hemorrhage

QJM ◽

10.1093/qjmed/hcaa056.014 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

K M Diab ◽

R M Mohamed ◽

A G Abdelhay

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Tranexamic Acid ◽

Maternal Mortality ◽

Vaginal Delivery ◽

Control Group ◽

Study Group ◽

Control Groups ◽

Significant Difference ◽

And Control

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks’ gestation are at risk for PPH and its sequelae. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Aim of the Work To assess the efficacy and safety intravenous tranexamic acid in reduction of amount of blood loss in high risk women who deliver by cesarean section or vaginal delivery in postpartum period. Patients and Methods This prospective double blind randomized controlled clinical trial study was conducted on 200 patients planned for LSCS or vaginal delivery at Gestational Age ≥ 34 Weeks at Ain Shams University Maternity Hospital. Recruitment of data begun once the protocol was approved by research and ethical committee of the department of obstetrics and gynecology. Results No significant difference between Study and Control groups as regards age (p = 0.508), no significant difference between Study and Control groups as regards Gestational age (p = 0.447),total blood loss (p < 0.001) was significantly lower in study group than control group, Vaginal pads in the 1st 24 hours post-partum was significantly less soaked in study group than control group (p < 0.001). no significant difference between Study and Control groups as regards Preoperative Hemoglobin, Postoperative Hemoglobin was significantly higher in study group than control group (p < 0.001), Reduction in Hemoglobin was significantly less in study group than control group (p < 0.001), no significant difference between Study and Control groups as regards Preoperative Hematocrite, Postoperative Hematocrit was significantly higher in study group than control group (p < 0.001), Reduction in Hematocrite was significantly less in study group than control group (p < 0.001).Need to iron replacement or blood transfusion was significantly less frequent in study group than control group (p = 0.24). Conclusion The use of tranexamic acid prior to cesarean section or vaginal delivery is effective as a prophylaxis against post-partum hemorrhage as shown by the results of this study. It can significantly reduce blood loss during and after cesarean section or vaginal delivery.

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Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III–IV calcaneal fractures

International Orthopaedics ◽

10.1007/s00264-021-05268-y ◽

2022 ◽

Author(s):

Lang Zhong ◽

Yangbo Xu ◽

Yongcai Wang ◽

Yu Liu ◽

Qiu Huang

Keyword(s):

Blood Loss ◽

Aminocaproic Acid ◽

Wound Complications ◽

Local Administration ◽

Control Group ◽

Calcaneal Fractures ◽

Operative Blood Loss ◽

Significant Difference ◽

Operative Drainage ◽

And Control

Abstract Purpose To investigate whether local administration of epsilon-aminocaproic acid (EACA) is effective and safe in reducing the post-operative blood loss in surgery for Sanders III–IV calcaneal fractures. Methods Patients with Sanders III–IV calcaneal fractures who were hospitalized in our hospital from January 2016 to February 2021 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the current study. Eighty five patients were randomly divided into two groups, EACA group (43) and control group (42). Twenty milliliters of 5% EACA solution or normal saline was perfused into the incision of patients in EACA group and control group, respectively. The volume of post-operative drainage was investigated as the primary outcome. Post-operative blood test, coagulation test, and wound complications were analyzed as the secondary outcomes. Results The volume of post-operative drainage at 24 and 48 h was 164.8 ± 51.4 ml, 18.9 ± 3.8 ml for patients in EACA group, and 373.0 ± 88.1 ml, 21.2 ± 4.4 ml for patients in the control group, respectively. EACA greatly reduced the post-operative blood loss compared to the control (normal saline). The difference between the two groups was statistically significant. No statistically significant difference was found between EACA group and control group with regard to the pre-operative, baseline characteristics. Post-operative blood test results demonstrated that haemoglobin and hematocrit were significantly higher in EACA compared to those of control group. No significant difference was found between EACA group and control group in terms of the platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications. Conclusion Local administration of EACA is effective in post-operative blood loss reduction in ORIF surgeries for Sanders III–IV types of calcaneal fractures without increasing the incidence of periwound complication.

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Emerging Barrier to Timely Care of Hip Fracture Patients: A Prospective Study of Direct Oral Anticoagulation and Time to Surgery

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v13i4.272 ◽

2018 ◽

Vol 13 (4) ◽

pp. e6-e9 ◽

Cited By ~ 1

Author(s):

Marlis T Sabo ◽

Fatima Mahdi ◽

Marcia Clark

Keyword(s):

Hip Fracture ◽

Surgical Management ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Prospective Audit ◽

Control Groups ◽

Time To Surgery ◽

A Prospective Study ◽

And Control ◽

The Impact

Introduction: Rapid surgical management of hip fracture patients is critical to reduce morbidity and mortality. These patients may be anti-coagulated and the new direct oral anticoagulants (DOAC) may introduce delays to treatment. Our purpose was to examine the impact of these DOAC on time to surgical management for hip fracture patients.Methods: A prospective audit of 55 consecutive operative hip fracture patients examined time from diagnosis to surgery. Indications for anticoagulation were recorded.Results: Time to surgery for the DOAC group was 66±16 hours, versus 38±21 and 25±19 hours for warfarin and control groups, respectively (P<0.05). Anticoagulation was for atrial fibrillation in 93%.Conclusion: Patients on DOAC faced significant delays to surgery. Given that both DOAC use and incidence of hip fracture are expected to rise, this presents a barrier to optimized care in this vulnerable group.

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Comparison of efficiency and safety of rivaroxaban, apixaban and enoxaparin for thromboprophylaxis after arthroplastic surgery: a meta-analysis

Bioscience Reports ◽

10.1042/bsr20180423 ◽

2018 ◽

Vol 38 (6) ◽

Cited By ~ 2

Author(s):

Zhi Yu ◽

Ping Shan ◽

Xiaoxia Yang ◽

Xin-jiang Lou

Keyword(s):

Meta Analysis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Recent Decade ◽

Control Group ◽

Control Groups ◽

Bleeding Events ◽

Wide Range ◽

Significant Difference ◽

Safety Outcomes

Objective: To compare the efficacy and safety of rivaroxaban, apixaban and enoxaparin for thromboprophylaxis after arthroplastic surgery. Methods: We conducted a meta-analysis containing a wide range of randomized controlled trials about efficiency and safety of rivaroxaban, apixaban and enoxaparin for thromboprophylaxis after arthroplastic surgery in the recent decade from January 2006 to June 2018. The present study separately analyzed the following key components: the different efficiency and safety for rivaroxaban and enoxaparin; apixaban and enoxaparin; and enoxaparin and other new developed anticoagulants. Results: Sixteen studies containing 58885 patients were included. In results of efficacy outcomes, total events occurred in 4.89% patients of rivaroxaban group and 9.55% patients of the control group; however, no significant difference was observed in apixaban groups of their efficacy outcomes. Primary events didn’t show significant difference when comparing apixaban with the control or comparing enoxaparin with the control. In analysis of safety outcomes, bleeding events occurred in 3.41% patients of rivaroxaban group compared with 2.84% patients of the control groups; bleeding events in apixaban groups were 4.09% compared with the control groups 4.64%. Bleeding events occurred in 3.51% patients of enoxaparin group, slightly lower than 5.82% of the control group. Conclusion: Direct oral anticoagulant, rivaroxaban might have better efficacy outcomes in thromboprophylaxis after arthroplastic surgery; however, apixaban showed no significantly different efficacy outcomes compared with enoxaparin, and enoxaparin may have equal or even better safety outcomes compared with direct oral anticoagulants.

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HIP FRACTURE

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.01.533 ◽

2018 ◽

Vol 25 (01) ◽

pp. 30-33

Author(s):

Abdul Malik Shaikh ◽

Muhammad Bakhsh Shahwani ◽

Mohammad Ishaq

Keyword(s):

Hip Fracture ◽

Pain Score ◽

Diclofenac Sodium ◽

Control Group ◽

College Hospital ◽

Medical College ◽

Significant Difference ◽

Fracture Study ◽

And Control ◽

Skin Traction

Objectives: To compare mean pain score between skin traction versus withoutskin traction in cases presenting with hip fracture. Study Design: Multi-randomized controlledstudy. Setting: Department of Orthopaedics, Chandka Medical College Hospital Larkana andQazi Hussain Ahmad Medical Complex, Nowshera. Period: 1st October 2016 to 31st March2017. Materials and Methods: A total of 100 cases (50 in two groups) between 18-60 years ofage including both genders presenting with unilateral femur fracture within 72 hours of injurywere enrolled in this study. They were divided in two groups i.e. study and control group, studygroup was allotted to the cases undergoing traction while control was those without using skintraction. Intramuscular diclofenac sodium injection (75 gm) was used in all participants andfollowed up for two tablets of paracetamol (500 mg) on 8 hourly basis. Visual analogue scaleto record pain score, 0 was no pain and 10 was the severe pain, it was recorded at 24 hoursof application of traction and second measurement was recorded just few minutes before thesurgery is done. Results: In this study, mean age was calculated as 48.74+9.12 years, agerange was 18-60 years. Male participants were in majority by calculating 64% (n=32) in Studyand 58% (n=29) in control group while female cases were 36% (n=18) in cases and 42%(n=21) in control group. Mean pain score at 24 hours of traction in study and control group wasrecorded as 4.60+0.70 in study group and 5.30+0.82 in control group (P = 0.0553), showsa significant difference. Conclusion: Mean pain score is significantly reduced during first 24hours of application of skin traction as compared to those without it in cases with hip fractures,however, it has no significant effect on pain after 24 hours of application.

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Delayed Time to Emergency Hip Surgery in Patients Taking Oral Anticoagulants

Blood ◽

10.1182/blood-2019-128849 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2445-2445

Author(s):

Teresa Cafaro ◽

Vicky Tagalakis ◽

Maral Koolian ◽

Simard Camille

Keyword(s):

Hip Fracture ◽

Vitamin K ◽

Action Plan ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Group Versus ◽

Hip Fracture Surgery ◽

Significant Difference ◽

Time Of Admission

Abstract Introduction Surgical intervention within 48 hours of admission in patients with acute hip fractures has been associated to lower morbidity and mortality. Patients anticoagulated with Vitamin K Antagonists (VKAs) have longer time to corrective surgery than those not anticoagulated. Sparse data exists on time to surgery (TTS) in patients taking direct oral anticoagulants (DOACs). The aim of this study is to establish TTS among non-anticoagulated and anticoagulated patients taking either VKA or DOAC. Materials and Methods We conducted a retrospective cohort study of consecutive patients admitted with acute hip fracture between July 1, 2016 and December 31, 2017. Patient-, anticoagulant- and surgery-related characteristics were collected. The primary outcome was TTS calculated from time of admission. Median TTS with interquartile range (IQR) was compared among 3 groups of patients: DOAC, VKA and No OAC. Results A total of 472 patients were included: 12.5% (59/472) were anticoagulated (28/472 on VKAs and 31/472 on DOACs). Median TTS was longer in the VKA group [64 hours (IQR: 50-84)] and in the DOAC group [(61 hours; IQR: 42 to 77)] versus the No OAC group [44 hours (IQR: 28-63), p =0.0006 and p=0.003 respectively]. There was no significant difference in median TTS in the VKA group versus the DOAC group (p =0.6396). Conclusion Patients taking either VKA or DOAC have significant delays to emergency hip fracture surgery compared to those not anticoagulated. An action plan aimed at early identification and cessation of anticoagulation is warranted in this vulnerable group of patients. Keywords: Direct Oral anticoagulants, Vitamin K antagonists, Anticoagulation, Acute hip fracture, Emergency surgery Disclosures Tagalakis: BMS-Pfizer: Other: participated on ad boards; Sanofi Aventis: Other: investigator initiated grant;participated on ad boards; Pfizer: Other: participated on ad boards; Bayer: Other: participated on ad boards; Servier: Other: participated on ad boards.

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Levels of Prothrombin Fragment F1+2 in Patients with Hyperhomocysteinemia and a History of Venous Thromboembolism

Thrombosis and Haemostasis ◽

10.1055/s-0038-1665405 ◽

1997 ◽

Vol 78 (05) ◽

pp. 1327-1331 ◽

Cited By ~ 21

Author(s):

Paul A Kyrle ◽

Andreas Stümpflen ◽

Mirko Hirschl ◽

Christine Bialonczyk ◽

Kurt Herkner ◽

...

Keyword(s):

Venous Thromboembolism ◽

Thrombin Generation ◽

Oral Anticoagulant Therapy ◽

Oral Anticoagulants ◽

Control Group ◽

Prothrombin Fragment ◽

Hemostatic System ◽

Significant Difference ◽

System Activation ◽

One Year

SummaryIncreased thrombin generation occurs in many individuals with inherited defects in the antithrombin or protein C anticoagulant pathways and is also seen in patients with thrombosis without a defined clotting abnormality. Hyperhomocysteinemia (H-HC) is an important risk factor of venous thromboembolism (VTE). We prospectively followed 48 patients with H-HC (median age 62 years, range 26-83; 18 males) and 183 patients (median age 50 years, range 18-85; 83 males) without H-HC for a period of up to one year. Prothrombin fragment Fl+2 (Fl+2) was determined in the patient’s plasma as a measure of thrombin generation during and at several time points after discontinuation of secondary thromboprophylaxis with oral anticoagulants. While on anticoagulants, patients with H-HC had significantly higher Fl+2 levels than patients without H-HC (mean 0.52 ± 0.49 nmol/1, median 0.4, range 0.2-2.8, versus 0.36 ± 0.2 nmol/1, median 0.3, range 0.1-2.1; p = 0.02). Three weeks and 3,6,9 and 12 months after discontinuation of oral anticoagulants, up to 20% of the patients with H-HC and 5 to 6% without H-HC had higher Fl+2 levels than a corresponding age- and sex-matched control group. 16% of the patients with H-HC and 4% of the patients without H-HC had either Fl+2 levels above the upper limit of normal controls at least at 2 occasions or (an) elevated Fl+2 level(s) followed by recurrent VTE. No statistical significant difference in the Fl+2 levels was seen between patients with and without H-HC. We conclude that a permanent hemostatic system activation is detectable in a proportion of patients with H-HC after discontinuation of oral anticoagulant therapy following VTE. Furthermore, secondary thromboprophylaxis with conventional doses of oral anticoagulants may not be sufficient to suppress hemostatic system activation in patients with H-HC.

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Effects of Virgin Coconut Oil as Adjunct Therapy in the Treatment of Allergic Rhinitis

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v1i1.5850 ◽

2016 ◽

Vol 1 (1) ◽

pp. 22

Author(s):

Nazli Zainuddin ◽

Nurul Azira Mohd Shah ◽

Rosdan Salim

Keyword(s):

Allergic Rhinitis ◽

Side Effects ◽

Coconut Oil ◽

Test Group ◽

Nasal Symptom ◽

Control Group ◽

Virgin Coconut Oil ◽

Control Groups ◽

Significant Difference ◽

And Control

Introduction: The role of virgin coconut oil in the treatment of allergic rhinitis is controversial. Thus, the aim of the present study is to determine the effects of virgin coconut oil ingestion, in addition to standard medications, on allergic rhinitis. We also studied the side effects of consumption of virgin coconut oil. Methods: Fifty two subjects were equally divided into test and control groups. All subjects received a daily dose of 10mg of loratadine for 28 days. The test group was given 10ml of virgin coconut oil three times a day in addition to loratadine. The symptoms of allergic rhinitis were scored at the beginning and end of the study. Results:, the symptom score were divided into nasal and non-nasal symptom scores. Sneezing score showed a significant difference, however the score was more in control group than test group, indicating that improvement in symptom was more in control group. The rest of the nasal symptom and non-nasal symptom score showed no significant difference between test and control groups. Approximately 58% of the test subjects developed side effects from consumption of virgin coconut oil, mainly gastrointestinal side effects. Conclusion: In the present study, ingestion of virgin coconut oil does not improve the overall and individual symptoms of allergic rhinitis, furthermore it has side effects.

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Enrichment of common carp (Cyprinus carpio) diet with Malic acid: Effects on skin mucosal immunity, antioxidant defecne and growth performance

Annals of Animal Science ◽

10.2478/aoas-2020-0092 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Roghieh Safari ◽

Seyed Hossein Hoseinifar ◽

Maryam Dadar ◽

Hien Van Doan

Keyword(s):

Common Carp ◽

Cyprinus Carpio ◽

Malic Acid ◽

Control Group ◽

Skin Mucus ◽

Antioxidant Genes ◽

Treatment Comparison ◽

Genes Expression ◽

Significant Difference ◽

And Control

AbstractThe present study investigated possible effects of dietary malic acid on the expression of immunity, antioxidant and growth related genes expression as well as skin mucus immune parameters in common carp. Common carp (Cyprinus carpio) fingerlings were fed diets supplemented with different levels (0 [control], 0.5%, 1%, 2%) of malic acid (MA) for 60 days. The results revealed highest expression levels of immune-related genes (tnf-alpha, il1b, il8 and lyz) in skin of common carp fed 2% MA (P < 0.05). Regarding 1% MA treatment comparison with control group, significant difference was noticed just in case of lyz (P < 0.05). Evaluation of growth related genes expression revealed no significant difference between treatments (P > 0.05). The study of antioxidant related genes (gsta and gpx) in common carp skin fed with MA, showed significant difference between treated groups and control (P < 0.05). Carps fed with 2% MA had highest alkaline phosphatase activity in skin mucus compared other treated groups and control (P < 0.05). There were no significant difference between 0.5% and 1% and control (P > 0.05). The study of total protein and total immunoglobulin (Ig) in common carp skin musus revealed no alteration following MA treatment (P > 0.05). The present data demonstrated that feeding with MA altered immune and antioxidant genes expression in skin mucus of common carp.

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THE EFFECT OF THE ATTITUDE TOWARD BREASTFEEDING CONCEPT BASED COMIC ON THE ADOLESCENCE'S ATTITUDE TOWARD EXCLUSIVE BREASTFEEDING

INDONESIAN NURSING JOURNAL OF EDUCATION AND CLINIC (INJEC) ◽

10.24990/injec.v1i2.118 ◽

2017 ◽

Vol 1 (2) ◽

pp. 138

Author(s):

Mekar Dwi Anggraeni ◽

Lutfatul Latifah ◽

Aprilia Kartikasari ◽

Ima Rismawati

Keyword(s):

Exclusive Breastfeeding ◽

Nuclear Family ◽

T Test ◽

Breastfeeding Duration ◽

Control Group ◽

Marriage Age ◽

First Marriage ◽

Significant Difference ◽

Post Test ◽

And Control

Background and purpose: The earlier development of the attitude toward exclusive breastfeeding produces the longer exclusive breastfeeding duration. Considering the first marriage age among Indonesian, the attitude toward exclusive breastfeeding should be developed at the adolescence age. The purpose of this study was to examine the effect of the attitude toward breastfeeding concept based comic on the adolescent's attitude toward exclusive breastfeeding. Method: This was a quasy experimental posttest only with control group study. The respondents were provided an comic. The respondent's attitude toward exclusive breastfeeding was measured using The Breastfeeding Attitude Questionnaire. Data were analyzed using independent and dependent t test. Results: The majority of respondents were aged 17 years old in both intervention (70%) and control grup (63%), first child in both intervention (23,3%) and control grup (26,7%), and had a nuclear family in both intervention (80%) and control grup (90%). The independent t test showed that there was a significant difference between post-test scores among the intervention and control groups (t = 5,602, p < 0,01). Conclusion and recommendation: Nurses may use the Attitude Toward Breastfeeding based comic to increase the Adolescence's attitude toward breastfeeding.Keywords: Comic, Attitudes Toward Exclusive Breastfeeding, Adolescence

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