Effect of Prothrombin Complex Concentrates on Time to Surgery in Patients with Hip Fracture Anticoagulated with Vitamin K Antagonists: A Retrospective Cohort Study

Abstract

Objectives: To determine the time to surgery (TTS) among patients with acute hip fracture who are anticoagulated with vitamin K antagonists (VKAs) who receive prothrombic complex concentrate (PCC) compared to those who do not receive PCC. Method: We conducted a retrospective cohort study of consecutive patients with an acute hip fracture presenting to the emergency department (ED) of the Jewish General Hospital, a 637-bed tertiary care hospital center in Montreal, Quebec, between January 1st, 2015 and March 1st, 2020. Eligible patients were identified via the ED electronic database. Inclusion criteria were: (1) > 18 years of age; (2) acute hip fracture and admission for surgical repair; (3) VKA use and international normalized ratio (INR) > 1.5 at admission. Follow-up was limited to index hospitalization. The primary outcome of TTS, reported in hours, was defined as the time from hospital admission to the time of surgery. Mann-Whitney U test was used to assess any difference in median TTS between the two groups. Results: A total of 53 patients were included in our cohort of which 43.4% (23/53) received PCC with a median time to first dose of 25.5 hours (IQR 19.4-51.6). 84.9 % (45/53) received vitamin K with a median time to the first dose of 16 h (IQR 7.5-26.7). The median TTS in the PCC and no PCC groups was 51.8 h (IQR 26.8–71.4) vs. 63.5 h (IQR 49.4-73.2) respectively (p=0.71). Conclusion: This study did not identify shorter TTS between patients who received PCC and those who did not. Median TTS in both groups surpassed the recommended 48h benchmark, and PCC and vitamin K administration timing was suboptimal. These findings demonstrate a significant care gap among this vulnerable population and represent a call for future initiatives to ensure a more streamlined and multidisciplinary approach to anticoagulation management starting at the onset of presentation.