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Authors
Abstract(s)
Introdução: As fraturas proximais do fémur estão associadas a maior morbilidade e
comprometimento funcional nos idosos. A cirurgia precoce, realizada nas primeiras 48
horas, relaciona-se com um melhor prognóstico. Contudo, muitos destes doentes estão sob
terapêutica antiagregante ou anticoagulante, cujo manuseio perioperatório faz atrasar a
cirurgia. O objetivo principal deste trabalho é relacionar a toma destes fármacos em idosos
com fratura proximal do fémur tratada cirurgicamente, com o tempo de espera para
cirurgia, tempo de internamento, complicações pré e pós-operatórias, transfusões de
concentrados de eritrócitos e mortalidade a 1 ano.
Métodos: Foi realizado um estudo retrospetivo observacional através da consulta de
processos clínicos de indivíduos idosos com episódios de fratura proximal do fémur
tratadas cirurgicamente, no Centro Hospitalar Universitário Cova da Beira, em 2017 e
2018. Os indivíduos foram agrupados de acordo com as suas comorbilidades,
quantificadas pelo Charlson Comorbidity Index.
Resultados: Foram contabilizados 245 casos. 23.7% dos doentes estavam antiagregados,
enquanto 18.8% estavam anticoagulados. A maioria (54.3%) dos indivíduos teve
complicações, sendo que a mortalidade a 1 ano foi de 15.1%. O tempo médio de
internamento foi de cerca de 14 dias e 53.9% das cirurgias foram realizadas precocemente.
Verificou-se uma relação estatisticamente significativa entre a toma de antiagregantes ou
anticoagulantes e o tempo de espera para cirurgia e o tempo de internamento. Não houve
relação significativa entre a toma destes fármacos e as complicações, transfusões de
concentrados de eritrócitos e mortalidade a 1 ano.
Conclusão: Os antiagregantes e anticoagulantes não parecem influenciar isoladamente o
prognóstico de doentes com fratura proximal do fémur em idosos com comorbilidades.
Nestes doentes, a descompensação de comorbilidades é provavelmente o fator que mais
contribui negativamente para o prognóstico.
Introduction: Proximal femoral fractures are associated with increased morbidity and functional impairment in the elderly. Early surgery, performed in the first 48 hours, is related to a better prognosis. However, many of these patients are under antiplatelet or anticoagulant therapy, whose peri-operative management delays the surgery. The main objective of this study is to relate the taking of these drugs, in patients with proximal femoral fracture surgically treated, with the waiting time for surgery, hospitalization time, preoperative and postoperative complications, transfusions of erythrocyte concentrates and 1-year mortality. Methods: An observational retrospective study was performed by consulting clinical processes of elderly individuals with episodes of proximal femur fracture surgically treated at the Cova da Beira University Hospital Center in 2017 and 2018. The individuals were grouped according to their comorbidities, quantified by the Charlson Comorbidity Index. Results: 245 cases were accounted for. 23.7% of patients were taking antiplatelets, while 18.8% were taking anticoagulants. The majority (54.3%) of individuals had complications, with a 1-year mortality of 15.1%. The average length of stay was nearly 14 days and 53.9% of the surgeries were performed early. There was a statistically significant relationship between the use of antiplatelets or anticoagulants and the waiting time for surgery, as well as the length of stay. There was no significant relationship between the taking of these drugs and complications, erythrocyte concentrate transfusions and 1-year mortality. Conclusion: As an independent factor, antiplatelets and anticoagulants do not seem to influence the prognosis of patients with proximal femoral fractures, in elderly patients with comorbidities. In these patients, decompensation of comorbid disorders is probably the factor that most negatively contributes to the prognosis.
Introduction: Proximal femoral fractures are associated with increased morbidity and functional impairment in the elderly. Early surgery, performed in the first 48 hours, is related to a better prognosis. However, many of these patients are under antiplatelet or anticoagulant therapy, whose peri-operative management delays the surgery. The main objective of this study is to relate the taking of these drugs, in patients with proximal femoral fracture surgically treated, with the waiting time for surgery, hospitalization time, preoperative and postoperative complications, transfusions of erythrocyte concentrates and 1-year mortality. Methods: An observational retrospective study was performed by consulting clinical processes of elderly individuals with episodes of proximal femur fracture surgically treated at the Cova da Beira University Hospital Center in 2017 and 2018. The individuals were grouped according to their comorbidities, quantified by the Charlson Comorbidity Index. Results: 245 cases were accounted for. 23.7% of patients were taking antiplatelets, while 18.8% were taking anticoagulants. The majority (54.3%) of individuals had complications, with a 1-year mortality of 15.1%. The average length of stay was nearly 14 days and 53.9% of the surgeries were performed early. There was a statistically significant relationship between the use of antiplatelets or anticoagulants and the waiting time for surgery, as well as the length of stay. There was no significant relationship between the taking of these drugs and complications, erythrocyte concentrate transfusions and 1-year mortality. Conclusion: As an independent factor, antiplatelets and anticoagulants do not seem to influence the prognosis of patients with proximal femoral fractures, in elderly patients with comorbidities. In these patients, decompensation of comorbid disorders is probably the factor that most negatively contributes to the prognosis.
Description
Keywords
Antiagregante Anticoagulante Fratura Proximal do Fémur Prognóstico