The following is a summary of “Safety of continuous fascia iliaca block in patients with hip fracture taking pre-injury anticoagulant and/or antiplatelet medications,” published in the December 2022 issue of Surgery by Sucher, et al.
Adult trauma patients with hip fractures can effectively manage pain using fascia iliaca compartment block (FICB). The high incidence of anticoagulant and antiplatelet drugs prior to injury in the cohort was significant. The safety of FICB with continuous catheter infusion in patients on antiplatelet and/or anticoagulant treatment had not been specifically assessed in the literature. For a study, researchers sought to evaluate the FICB complication rate in patients who are actively taking anticoagulant and/or antiplatelet drugs as recommended prior to injury and to pinpoint risk variables that might put patients at risk for negative outcomes.
In the retrospective investigation, consecutive adult trauma patients with hip fractures (age ≥18) who received FICB placement within 24 hours of admission and who were taking anticoagulant and/or antiplatelet drugs before to injury were included. If a patient’s catheter placement occurred more than 24 hours after hospital admission, they were disqualified. Patient characteristics, injury severity, laboratory results, medication history, use of coagulation-related reversal drugs, and FICB placement-related problems were all assessed. A 30-day catheter site infection and bleeding at the insertion site that necessitated catheter removal were complications. Using univariate and multivariate statistics, the incidence of complications was reported and risk variables for complications were found.
About 124 patients were included. The most frequent mechanism (and one with a mean age of 81 ± 10 years) was ground level fall (94%). The majority of patients (65%) were receiving only one antiplatelet treatment, which was followed by anticoagulant alone (21%), combination antiplatelet and anticoagulant therapy (7.3%), and dual antiplatelet therapy (7.3%). Aspirin was the most popular antiplatelet drug (88%) while warfarin was the most popular anticoagulant (60%). The average INR at admission for the warfarin-taking individuals was 2.3 ± 0.8. One patient who was taken clopidogrel before to injury experienced just one bleeding issue (0.8%), which happened five days after the catheter was inserted. The same patient’s superficial surgical site bleeding was detected, and it was most likely because enoxaparin was used as post-operative deep vein thrombosis prevention. Four (3.2%) superficial surgical site infections related to orthopedic surgery occurred away from the catheter site. Aspirin 81 mg, aspirin 325 mg, rivaroxaban, and dabigatran were the pre-injury medications administered for these individuals, respectively. Multivariate analysis was not done because there were no variables connected to any complications.
Adult trauma patients on pre-injury anticoagulants or antiplatelet medicines seldom experience fascia iliaca compartment block (FICB) problems. They could not find any issues in the retrospective evaluation that were directly related to the FICB technique. Patients using therapeutic anticoagulants and/or antiplatelet medications can safely have their fascia iliaca blocked with a continuous infusion catheter placed.
Reference: americanjournalofsurgery.com/article/S0002-9610(22)00542-6/fulltext
