vitamin-k-semiquinone-radical and Femoral-Neck-Fractures

Anticoagulant prophylaxis for preventing venous thrombembolism (VTE) is a worldwide established procedure in hip (HR) and knee replacement (KR) surgery, as well as in the treatment of femoral neck fractures (FNF). Different guidelines are available in the literature, with quite different recommendations. None of them is a multidisciplinary effort as the one presented. The Italian Society for Studies on Hemostasis and Thrombosis, the Italian Society of Orthopedics and Traumatology, the association of Orthopedic Traumatology of Italian Hospitals, together with the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care have set down easy and quick suggestions for VTE prophylaxis in HR and KR surgery as well as in FNF treatment. This inter-society consensus statement aims at simplifying the grading system reported in the literature, and thus at improving its proper application. Special focus is given to fragile patients, those with high bleeding risk, and on those receiving chronic antiplatelet and vitamin K antagonists treatment. A special chapter is dedicated to regional anesthesia and VTE prophylaxis.

Topics: Anesthesia; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Consensus; Femoral Neck Fractures; Fibrinolytic Agents; Fondaparinux; Heparin, Low-Molecular-Weight; Humans; Orthopedic Procedures; Patient Safety; Polysaccharides; Postoperative Complications; Postoperative Hemorrhage; Risk; Stockings, Compression; Thrombosis; Venous Thromboembolism; Vitamin K

Undercarboxylated osteocalcin (ucOC) is a sensitive marker of vitamin K (VK) status. Serum ucOC concentration in perimenopausal women is significantly higher than that in premenopausal women. In addition, serum ucOC concentration is closely associated with not only FSH concentration but also estradiol concentration. Serum ucOC concentration rapidly increases in women after bilateral oophorectomy. The effect of hormone therapy (HT) on alternate days on ucOC concentration is weaker than the effect of HT daily and ucOC concentration after 12 months of HT daily may be decreased due to the conversion of ucOC to carboxylated OC by the effect of VK through increased TG induced by oral conjugated equine estrogen (CEE) . Additionally, the effect of HT with transdermal estradiol on ucOC concentration in women is weaker than the effect of HT with oral CEE.

Topics: Biomarkers; Estradiol; Estrogen Replacement Therapy; Female; Femoral Neck Fractures; Follicle Stimulating Hormone; Humans; Menopause; Osteocalcin; Osteoporosis, Postmenopausal; Ovariectomy; Risk; Triglycerides; Vitamin K; Vitamin K Deficiency

Topics: Animals; Bone and Bones; Femoral Neck Fractures; Fractures, Stress; Humans; Osteocalcin; Osteoporosis; Spinal Fractures; Vitamin K

Topics: Anticoagulants; Dextrans; Dipyridamole; Femoral Neck Fractures; Heparin; Hip Joint; Humans; Hydroxychloroquine; Joint Prosthesis; Postoperative Complications; Risk; Thromboembolism; Thrombophlebitis; Vitamin K

The objective of this prospective audit was to compare two methods of anticoagulation reversal in the pre-operative period for hip fracture patients.. In the first part of the audit, our current practice was analysed. Data relating to the number of days from admission to surgery and the reasons for delay to surgery were collected. Also, data concerning common reasons for which the patients were started on warfarin and the time required for INR to drop to 1.5 or below were collected. In the second part of the audit, 45 patients with INR above 1.5 were given a single dose of vitamin K (1 mg i.v.) in addition to stopping warfarin.. The mean difference in the time for INR < 1.5 in the two groups was 2 days (52 h; P < 0.05). The mean difference in wait for surgery since admission between the two groups was 4 days (91 h; P < 0.05). There was no significant difference between the two groups as regards the average number of co-morbidities in the patient groups.. A single 1 mg intravenous dose of vitamin K significantly reduces the time for the reversal of INR and the pre-operative delay to surgery, in patients on long-term warfarin. We conclude that 1 mg of intravenous vitamin K on admission is a safe and effective treatment to avoid delay in the treatment in this group of patients.

Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Blood Coagulation; Female; Femoral Neck Fractures; Fracture Fixation; Humans; International Normalized Ratio; Male; Medical Audit; Practice Guidelines as Topic; Preoperative Care; Preoperative Period; Vitamin K; Warfarin

PURPOSE. To compare the effects of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients. METHODS. Records of 7 men and 17 women aged 68 to 93 (mean, 82) years who were on warfarin and underwent surgery for femoral neck fractures were reviewed. The time to surgery, complication rate, and mortality were recorded, as were the International Normalised Ratio (INR) on admission and the day of operation, as well as the dose, route, and time of administration of vitamin K for reversing the anticoagulation effect of warfarin. Patients were divided into 4 groups based on the warfarin reversal treatment. Group 1 (n=4) included patients who did not receive reversal treatment, as their admission INR was 1.5 or less. Group 2 (n=6) included patients who did not receive reversal treatment even though their INR was >1.6. Group 3 (n=5) included patients who received inappropriate reversal treatment (late or low-dose oral administration). Group 4 (n=9) included patients who received appropriate reversal treatment in terms of dose, route, and time of administration. RESULTS. Among the 4 groups, the mean INR was 2.2 (range, 1.3-4.6) on admission and 1.4 (range, 1.0-1.6) on the day of surgery. Group 1 was excluded from further analysis. Respectively in groups 2, 3, and 4, the mean times to surgery were 2.3, 2.6, and 1.2 days, and the complication rates were 67%, 20%, and 11%. CONCLUSION. Early administration of intravenous vitamin K for hip fracture patients on warfarin is recommended to ensure early operative management and avoid postoperative complications.

Topics: Aged; Aged, 80 and over; Anticoagulants; Antifibrinolytic Agents; Clinical Protocols; Female; Femoral Neck Fractures; Hemorrhage; Humans; Male; Thromboembolism; Time Factors; Vitamin K; Warfarin

Topics: Anticoagulants; Emergencies; Femoral Neck Fractures; Humans; Injections, Intravenous; International Normalized Ratio; Preoperative Care; Time Factors; Vitamin K; Warfarin

A 87-year-old patient developed coagulation abnormality following hip surgery related to the prophylactic use of cefamandole. Cefamandole as others cephalosporins with a methyl-tetrazol-thiol lateral chain interferes with the vitamin K regeneration cycle as do oral anticoagulants. Therefore, the use of others antibiotics or systematic vitamin K1 supplementation or single dose of cefamandole is recommended for patients with renal failure or with malnutrition. Vitamin K1 supplementation is a simple method resulting in complete resolution of the coagulation disorder.

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Arthroplasty, Replacement, Hip; Cefamandole; Cephalosporins; Female; Femoral Neck Fractures; Hematoma; Hemorrhagic Disorders; Humans; Postoperative Complications; Vitamin K; Vitamin K Deficiency

Vitamin K1 functions in the conversion of glutamate residues, present in certain bone peptides, into the putatively active gamma-carboxyglutamate form. We have shown previously that the circulating levels of vitamin K1 are depressed in osteoporotic patients. However, it is known that menaquinones (vitamin K2:MK) may be more effective than vitamin K1 in this conversion of the inactive to active form of glutamate residues. A procedure for measuring such menaquinones has now demonstrated a marked deficiency of MK-7 and MK-8 in patients with osteoporotic fractures. It is suggested that estimates of circulating levels of K1, MK-7, and MK-8 might provide a biochemical risk marker of osteoporotic fractures.

Topics: Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Humans; Male; Middle Aged; Osteoporosis; Spinal Fractures; Vitamin K; Vitamin K 2

Topics: Adolescent; Adult; Aged; Anticoagulants; Female; Femoral Neck Fractures; Femur Head; Heparin; Hip Fractures; Humans; Male; Middle Aged; Postoperative Complications; Vitamin K