[FEMORAL HEAD FRACTURE IN PATIENTS 65 YEARS AND OLDER WITH ATRIAL FIBRILLATION: THE EFFECT OF ANTI-COAGULATION ON COMPLICATIONS AND PROGNOSIS].

ABSTRACT

BACKGROUND: Atrial fibrillation and hip fractures are common problems in elderly patients. Delay in the timing of surgical repair can lead to increased complications and anti-coagulation could be a reason for delay. OBJECTIVES: To assess morbidity and mortality in patients 65 years and older with atrial fibrillation (AF) and hip fracture in relation to the type of anti-coagulation. METHODS: A retrospective cross-sectional study of patients with AF and hip fracture aged 65 and older was conducted in a tertiary hospital. Data collected included co-morbidity, medical history, medications, the timing of surgery, thromboembolic events, estimated risk for stroke by CHADS2 score, for significant bleeding by HAS-BLED score and mortality rate for the six-month period following surgery. RESULTS: During the period 2014-2016, 186 patients 65 years and older with atrial fibrillation underwent surgical repair of a hip fracture, 113 (60.7%) women. The mean age was 81.9±7.1 years. Eighty-nine (47.8%) did not receive any anti-coagulation, 60 (32.3%) received new oral anticoagulants (NOAC), and 37 (19.9%) warfarin. There were no differences between these groups on pre-and post-operation burden of co-morbidity, timing of surgery, surgical delay, complication rate, or mortality rate during the six months following surgery. CONCLUSIONS: Anti-coagulation for patients 65 years and older with atrial fibrillation and hip fracture did not affect the timing of surgery or the rate of complications and mortality. Based on these results the concern over emergency surgery and its complications in patients with AF is not justified.