The perioperative management of oral chronic anticoagulation therapy in patients with hip fractures

Hip fractures are serious traumatic injuries, especially of the elder patients. The general consequences are long-term functional impairment, nursing home admission and increased mortality. Improving outcomes after hip fractures is translated in improving attention to details, especially cardiovascular disease that necessitates chronic anticoagulant therapy. The management of the anticoagulant therapy in the perioperative period is challenging. It usually needs stopping the oral anticoagulant therapy and changing to subcutanous infections with heparin products. This period of alternation between the two types of anticoagulants is critical and difficult to supervise because it must not increase bleeding risk and also prevent thromboembolic events. Lately, in the therapeutic arsenal of the cardiovascular pathology, have been introduced the new anticoagulants that have a lower bleeding risk and a easier administration and compliance to treatment. Not all of these management strategies are backed by data come from studies. We suggest here our strategy of managing these complex patients; that is a compilation of guideline strategies, information from expert publications and our own clinical experience.