warfarin and Fractures--Bone

Background Evidence on the differences in fracture risk associated with non-vitamin K antagonist oral anticoagulants (NOAC) and warfarin is inconsistent and inconclusive. We conducted a systematic review and meta-analysis to assess the fracture risk associated with NOACs and warfarin. Methods and Results We searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov from inception until May 19, 2020. We included studies presenting measurements (regardless of primary/secondary/tertiary/safety outcomes) for any fracture in both NOAC and warfarin users. Two or more reviewers independently screened relevant articles, extracted data, and performed quality assessments. Data were retrieved to synthesize the pooled relative risk (RR) of fractures associated with NOACs versus warfarin. Random-effects models were used for data synthesis. We included 29 studies (5 cohort studies and 24 randomized controlled trials) with 388 209 patients. Patients treated with NOACs had lower risks of fracture than those treated with warfarin (pooled RR, 0.84; 95% CI, 0.77-0.91;

Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Fractures, Bone; Global Health; Humans; Incidence; Stroke; Warfarin

The use of warfarin in the elderly, particularly for stroke prevention in chronic atrial fibrillation, is steadily increasing. Although the benefits of warfarin are greatest in the elderly, so are the risk of adverse outcomes and the difficulties of anticoagulant management. Clinical systems need to improve to counter this therapeutic dilemma, as warfarin is likely to remain the only widely available oral anticoagulant for the foreseeable future. Aspects that require attention are: the careful selection of patients in whom treatment with warfarin is appropriate; initiating therapy in a low dose (e.g., 2.5-5 mg/day); thorough education of patients and carers; close monitoring, especially with any change in the patient's regular drug therapy; involving patients more in the management of their warfarin therapy (self-monitoring/management in suitable patients); and ongoing review of the appropriateness of therapy as circumstances change.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Azetidines; Benzylamines; Drug Interactions; Drug Monitoring; Fractures, Bone; Hemorrhage; Humans; Stroke; Warfarin

We describe a case of a patient receiving warfarin who presented with a superior pubic ramus fracture after a trivial fall at home. She developed a massive retroperitoneal haematoma as a result of vascular injury and subsequently died. This case emphasises the importance of admitting and observing patients with pubic rami fractures who are receiving antithrombotic treatment, and haemorrhage should be considered if they become haemodynamically compromised.

Topics: Accidental Falls; Aged; Anticoagulants; Fatal Outcome; Female; Fractures, Bone; Hematoma; Humans; Pubic Bone; Retroperitoneal Space; Warfarin

Patients sustaining traumatic injuries are at high risk for the development of venous thromboembolism. The reported incidence of deep venous thrombosis in trauma patients ranges from 20 to 90%. The reported incidence of pulmonary embolism in trauma patients varies between 2.3 and 22%. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patient population. There have been few randomized prospective studies assessing methods of thromboembolism prophylaxis in trauma patients. Controversy exists as to the optimal method of prophylaxis in this high-risk population. Contraindications arising from associated injuries often limit the potential options for prophylaxis in patients with trauma. Large prospective randomized studies are needed to determine the most effective means of prophylaxis in trauma patients, who have a wide range of both isolated and combined injuries. Future studies should also address the duration of prophylaxis because many trauma patients remain immobile for an extended time.

Topics: Aged; Anticoagulants; Clinical Trials as Topic; Diagnosis, Differential; Female; Fractures, Bone; Heparin; Heparin, Low-Molecular-Weight; Humans; Incidence; Leg; Male; Middle Aged; Risk Factors; Thromboembolism; Vena Cava Filters; Venous Thrombosis; Warfarin; Wounds and Injuries

Two recent studies examined the association between chronic use of warfarin, a vitamin K antagonist, and fracture rate among older women. Whereas one study reported no association, the other reported a significantly higher risk for vertebral and rib fractures among warfarin users compared with nonusers. The effect of vitamin K antagonists on age-related bone loss continues to be controversial.

Topics: Animals; Anticoagulants; Female; Fractures, Bone; Humans; Osteoporosis, Postmenopausal; Vitamin K; Warfarin; Women's Health

Topics: Aged; Anticoagulants; Aspirin; Bandages; Coumarins; Dextrans; Exercise Therapy; Femoral Neck Fractures; Fibrinogen; Fractures, Bone; Hemorrhage; Hip Injuries; Humans; Iodine Isotopes; Physical Exertion; Postoperative Care; Postoperative Complications; Pulmonary Embolism; Thromboembolism; Thrombophlebitis; Warfarin

Topics: Aged; Female; Femoral Neck Fractures; Fractures, Bone; Hip; Humans; Male; Pulmonary Embolism; Thrombophlebitis; Warfarin

Topics: Anticoagulants; Fractures, Bone; Humans; Warfarin

Warfarin is prescribed to patients with atrial fibrillation (AF) for the prevention of cardioembolic complications. Whether warfarin adversely affects bone health is controversial. The availability of alternate direct oral anticoagulant (DOAC) options now make it possible to evaluate the comparative safety of warfarin in association with fracture risk.. To test the hypothesis that, among patients with nonvalvular AF, use of DOACs vs warfarin is associated with lower risk of incident fracture.. This comparative effectiveness cohort study used the MarketScan administrative claims databases to identify patients with nonvalvular AF and who were prescribed oral anticoagulants from January 1, 2010, through September 30, 2015. To reduce confounding, patients were matched on age, sex, CHA2DS2-VASc (congestive heart failure, hypertension, age [>65 years = 1 point; >75 years = 2 points], diabetes, and previous stroke/transient ischemic attack [2 points], vascular disease) score, and high-dimensional propensity scores. The final analysis included 167 275 patients with AF. Data were analyzed from February 27, 2019 to September 18, 2019.. Warfarin and DOACs (dabigatran etexilate, rivaroxaban, and apixaban).. Incident hip fracture, fracture requiring hospitalization, and all clinical fractures (identified using inpatient or outpatient claims) defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes.. In the study population of 167 275 patients with AF (38.0% women and 62.0% men; mean [SD] age, 68.9 [12.5] years), a total of 817 hip fractures, 2013 hospitalized fractures, and 7294 total fractures occurred during a mean (SD) follow-up of 16.9 (13.7) months. In multivariable-adjusted, propensity score-matched Cox proportional hazards regression models, relative to new users of warfarin, new users of DOACs tended to be at lower risk of fractures requiring hospitalization (hazard ratio [HR], 0.87; 95% CI, 0.79-0.96) and all clinical fractures (HR, 0.93; 95% CI, 0.88-0.98), whereas the association with hip fractures (HR, 0.91; 95% CI, 0.78-1.07) was not statistically significant. When comparing individual DOACs with warfarin, the strongest findings were for apixaban (HR for hip fracture, 0.67 [95% CI, 0.45-0.98]; HR for fractures requiring hospitalization, 0.60 [95% CI, 0.47-0.78]; and HR for all clinical fractures, 0.86 [95% CI, 0.75-0.98]). In subgroup analyses, DOACs appeared more beneficial among patients with AF who also had a diagnosis of osteoporosis than among those without a diagnosis of osteoporosis.. In this real-world population of 167 275 patients with AF, use of DOACs-particularly apixaban-compared with warfarin use was associated with lower fracture risk. These associations were more pronounced among patients with a diagnosis of osteoporosis. Given the potential adverse effects of warfarin on bone health, these findings suggest that caution should be used when prescribing warfarin to patients with AF at high risk of fracture.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Comorbidity; Comparative Effectiveness Research; Dabigatran; Factor Xa Inhibitors; Female; Fractures, Bone; Hip Fractures; Hospitalization; Humans; Incidence; Male; Middle Aged; Osteoporosis; Proportional Hazards Models; Protective Factors; Pyrazoles; Pyridones; Rivaroxaban; Warfarin

Treatment and prognosis of elderly patients with atrial fibrillation (AF) may differ by the experience of fall or bone fracture. However, their current status is still unclear. From our institute database between 2010 and 2015, 674 AF patients with age ≥ 70 years were selected and were divided into those who experienced fall or fracture during the observation period (F/F group; n = 49) and those who did not (non-F/F group; n = 625). We compared the treatment and prognosis between the 2 groups. Patients in the F/F group were older (79 vs 76 years, P < 0.001) and had more comorbidities compared with those in the non-F/F group. The prescription rate of oral anticoagulant was similar between the two groups (77.6% vs 68.2%, P = 0.201), where warfarin was predominant. The F/F group was not associated with higher incidence of ischemic stroke. The F/F group was associated with a higher incidence of heart failure events (adjusted odds ratio (OR) 3.88; 95% confidence intervals (Cl) 1.70-8.85; P = 0.001), and cardiovascular events (OR 3.43; 95% Cl 1.71-6.85; P < 0.001). In elderly AF patients in a cardiovascular hospital, the experience of fall or fracture did not affect the prescription of oral anticoagulants and the incidence of ischemic stroke, but it was significantly associated with increase of heart failure.

Topics: Accidental Falls; Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Brain Ischemia; Databases, Factual; Female; Fractures, Bone; Heart Disease Risk Factors; Heart Failure; Humans; Incidence; Japan; Male; Risk Assessment; Stroke; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Aspirin; Blood Coagulation Factors; Cerebral Hemorrhage, Traumatic; Cerebral Intraventricular Hemorrhage; Clopidogrel; Deamino Arginine Vasopressin; Female; Fractures, Bone; Hematoma; Hematoma, Subdural, Intracranial; Hemostatics; Humans; International Normalized Ratio; Intracranial Hemorrhage, Traumatic; Male; Middle Aged; Pelvic Bones; Platelet Aggregation Inhibitors; Pyrazoles; Pyridones; Retrospective Studies; Rivaroxaban; Subarachnoid Hemorrhage, Traumatic; Thrombosis; Warfarin

Topics: Accidental Falls; Atrial Fibrillation; Fractures, Bone; Humans; Pyridines; Thiazoles; Warfarin

Successful vitamin K antagonist (eg, warfarin) reversal with 4-factor prothrombin complex concentrate (4F-PCC) without vitamin K (phytonadione) for emergent surgery in a patient at moderate-to-high risk for thromboembolism is reported. This approach may decrease the risk for development of thrombus, as it limits the amount of time the patient's anticoagulation is subtherapeutic. It also may increase the risk of bleeding, so patient selection is essential if this strategy is employed. Caution must be exercised to complete the procedure or surgery in the window of peak 4F-PCC effect (∼1-6 hours postinfusion).

Topics: Accidents, Traffic; Aged; Anticoagulants; Antifibrinolytic Agents; Atrial Fibrillation; Blood Coagulation Factors; Compartment Syndromes; Crush Injuries; Drug Hypersensitivity; Fibula; Fractures, Bone; Humans; International Normalized Ratio; Leg Injuries; Male; Preoperative Care; Stroke; Vitamin K; Warfarin

Topics: Animals; Anticoagulants; Bone and Bones; Bone Density; Evidence-Based Medicine; Female; Fractures, Bone; Humans; Male; Mice; Osteocalcin; Rats; Risk; Treatment Outcome; Warfarin

This represents the fifth article in the series on yearly updates of hot topics in long term care.

Topics: Anti-Ulcer Agents; Anticoagulants; Atrial Fibrillation; Clopidogrel; Clostridioides difficile; Delirium; Diabetes Complications; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Female; Fractures, Bone; Geriatric Nursing; Humans; Male; Nursing Homes; Omeprazole; Osteoporosis; Peptic Ulcer; Platelet Aggregation Inhibitors; Pneumonia, Bacterial; Polypharmacy; Proton Pump Inhibitors; Risk Factors; Ticlopidine; Warfarin; Weight Loss

To determine whether warfarin use, assessed at a single point in time, is associated with bone mineral density (BMD), rates of bone loss, and fracture risk in older men.. Secondary analysis of data from a prospective cohort study.. Six U.S. clinical centers.. Five thousand five hundred thirty-three community-dwelling, ambulatory men aged 65 and older with baseline warfarin use data.. Warfarin use was assessed as current use of warfarin at baseline using an electronic medication coding dictionary. BMD was measured at the hip and spine at baseline, and hip BMD was repeated at a follow-up visit 3.4 years later. Self-reported nonspine fractures were centrally adjudicated.. At baseline, the average age of the participants was 73.6 +/- 5.9, and 321 (5.8%) were taking warfarin. Warfarin users had similar baseline BMD as nonusers (n=5,212) at the hip and spine (total hip 0.966 +/- 0.008 vs 0.959 +/- 0.002 g/cm(2), P=.37; total spine 1.079 +/- 0.010 vs 1.074 +/- 0.003 g/cm(2), P=.64). Of subjects with BMD at both visits, warfarin users (n=150) also had similar annualized bone loss at the total hip as nonusers (n=2,683) (-0.509 +/- 0.082 vs -0.421 +/- 0.019%/year, P=.29). During a mean follow-up of 5.1 years, the risk of nonspine fracture was similar in warfarin users and nonusers (adjusted hazard ratio=1.06, 95% confidence interval=0.68-1.65).. In this cohort of elderly men, current warfarin use was not associated with lower BMD, accelerated bone loss, or higher nonspine fracture risk.

Topics: Absorptiometry, Photon; Aged; Anticoagulants; Bone Density; Follow-Up Studies; Fractures, Bone; Geriatric Assessment; Health Status; Humans; Male; Multicenter Studies as Topic; Osteoporosis; Risk Factors; Warfarin

Vitamin K (K) inadequacy may cause bone loss. Thus, K deficiency induced by anticoagulants (e.g., warfarin) may be an osteoporosis risk factor. The skeletal impact of long-term warfarin anticoagulation was evaluated in male monkeys. No effect on BMD or bone markers of skeletal turnover was observed. This study suggests that warfarin-induced K deficiency does not have skeletal effects.. The skeletal role of vitamin K (K) remains unclear. It is reasonable that a potential role of vitamin K in bone health could be elucidated by study of patients receiving oral anticoagulants that act to produce vitamin K deficiency. However, some, but not all, reports find K deficiency induced by warfarin (W) anticoagulation to be associated with low bone mass. Additionally, epidemiologic studies have found W use to be associated with either increased or no change in fracture risk. Such divergent results may imply that human studies are compromised by the physical illnesses for which W was prescribed.. To remove this potential confounder, we prospectively assessed skeletal status during long-term W anticoagulation of healthy nonhuman primates. Twenty adult (age, 7.4-17.9 yr, mean, 11.7 yr) male rhesus monkeys (Macaca mulatta) were randomized to daily W treatment or control groups. Bone mass of the total body, lumbar spine, and distal and central radius was determined by DXA at baseline and after 3, 6, 9, 12, 18, 24, and 30 mo of W treatment. Serum chemistries, urinary calcium excretion, bone-specific alkaline phosphatase, and total and percent unbound osteocalcin were measured at the same time-points. Prothrombin time and international normalized ratio (INR) were monitored monthly. Serum 25-hydroxyvitamin D was measured at the time of study conclusion.. W treatment produced skeletal K deficiency documented by elevation of circulating undercarboxylated osteocalcin (8.3% W versus 0.4% control, p<0.0001) but did not alter serum markers of skeletal turnover, urinary calcium excretion, or BMD.. In male rhesus monkeys, long-term W anticoagulation does not alter serum markers of bone turnover or BMD. Long-term W therapy does not have adverse skeletal consequences in primates with high intakes of calcium and vitamin D.

Topics: Animals; Anticoagulants; Biomarkers; Bone Density; Bone Resorption; Calcium; Fractures, Bone; Lumbar Vertebrae; Macaca mulatta; Male; Radius; Risk Factors; Time Factors; Vitamin D; Vitamin K Deficiency; Warfarin

Long-term warfarin use has been reported to increase fracture risk of rib and vertebra but not hip in elderly patients, but the mechanisms remain unknown. We hypothesized that warfarin would impair bone material quality but could not weaken bone strength under conditions with higher mechanical stimuli. To test this hypothesis, rats were randomized to vehicle or warfarin group at 4 weeks of age and subsequently weight matched into a sedentary or jumping exercise group at 12 weeks of age. At 6 months of age, osteocalcin content, bone mineral density (BMD), mineral size, material properties, morphological parameters, and biomechanical properties of cortical bones were evaluated. In order to seek evidence for a common mechanism of action, effects of nucleation rate of mineral crystals on their rigidity were also investigated using computer simulation. In humeral cortical bones, warfarin did not change BMD, but markedly decreased osteocalcin content, diminished mineral size, and impaired material hardness. Consistent with these results, our computer-simulation model showed that osteocalcin-induced delay of mineral crystal nucleation decreased mineral formation rate, increased mean and distribution of mineral sizes, and strengthened mineral rigidity. In tibial cortical bones, warfarin decreased material ultimate stress; however, under jumping exercise, warfarin increased cross-sectional total and bone areas of these tibiae and completely maintained their biomechanical properties including work to failure. Collectively, our findings suggest that long-term warfarin therapy weakens rib and vertebra by impairing cortical bone material quality due to a marked decrease in osteocalcin content but could not reduce hip strength through compensatory adaptation of cortical bone structure to higher mechanical stimuli.

Topics: Adaptation, Physiological; Animals; Anticoagulants; Bone and Bones; Bone Density; Computer Simulation; Crystallization; Dose-Response Relationship, Drug; Female; Fractures, Bone; Models, Biological; Movement; Osteocalcin; Rats; Rats, Inbred F344; Risk; Stress, Mechanical; Time Factors; Warfarin

Topics: Aged; Anticoagulants; Fractures, Bone; Humans; Male; Osteoporosis; Vitamin K; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Fractures, Bone; Humans; Incidence; Osteoporosis; Retrospective Studies; Stroke; United States; Warfarin

This study examined the hypothesis that patients on warfarin before sustaining orthopedic injuries will have increased morbidity and mortality compared with matched control patients not on warfarin.. Records of consecutive trauma patients on warfarin with orthopedic fractures who presented from January 1997 to June 2002 to a Level I trauma center were retrospectively analyzed. Data were evaluated using the chi and Student's t tests and nonparametric tests when appropriate; values of p < 0.05 were considered significant.. A study group of 53 patients was available for review. In comparison with the control group, significant differences were found in time delay from admission to surgery (p = 0.005), hospital length of stay (p = 0.03), total units of blood transfused (p = 0.03), and discharge disposition (p < 0.0003). No difference was found in number of intensive care unit days, complications, or mortality.. Preinjury warfarin impacts outcomes of geriatric trauma patients sustaining orthopedic injuries.

Topics: Accidental Falls; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Female; Fractures, Bone; Humans; Male; Matched-Pair Analysis; Middle Aged; Orthopedic Procedures; Retrospective Studies; Risk Assessment; Treatment Outcome; United States; Warfarin

We assessed the serum concentration of gamma-carboxylated osteocalcin (OC), total OC, and full-length OC in a clinical setting of 37 patients on continuous warfarin treatment (international normalized ratio 2.0-3.8). A comparison was done with the results from 30 untreated age-matched controls. Four monoclonal antibodies, previously generated and characterized as to their ability to recognize different human OC forms and fragments, were used in three two-site immunofluorometric assays. The warfarin-treated patients had significantly lower levels of carboxylated OC 4.9 +/- 3.8 (+/- 1 SD) ng/ml compared with the controls 13.1 +/- 9.7 (p < 0.0001). There was no difference in the levels of total OC or full-length OC between the two groups of patients. A strong correlation was found between the serum concentration of carboxylated OC and total OC, both for the warfarin-treated patients (r = 0.98) and for the controls (r = 0.99). There was a distinct cut-off level at 0.80, in the quotient carboxylated OC/total OC, at which all warfarin-treated patients fell below and all controls above this level. Hence, the concentration or ratio of serum gamma-carboxylated OC in clinical settings such as warfarin-treated patients could be measured using two-site immunoassays.

Topics: Aged; Aged, 80 and over; Antibodies, Monoclonal; Anticoagulants; Carboxylic Acids; Case-Control Studies; Female; Fractures, Bone; Heart Diseases; Humans; Male; Middle Aged; Osteocalcin; Risk Factors; Thromboembolism; Warfarin

Vitamin K deficiency may be associated with osteoporosis.. To assess the effects of warfarin on bone.. Prospective observational study.. Four centers in the United States.. 6201 elderly, postmenopausal women.. Self-reported warfarin use, bone mineral density at the hip and the heel, hip bone loss over 2 years, and fractures during 3.5 years of follow-up. Analyses were adjusted for baseline differences, age, weight, and estrogen use.. Compared with warfarin nonusers (n = 6052), warfarin users (n = 149) more frequently had poor health, involuntary weight loss, nonthiazide diuretic use, and frailty but had similar bone mineral density at the hip (difference, 1.6% [95% CI, -0.7% to 4.1%]) and heel (difference, 2.1% [CI, -1.6% to 5.6%]). Users and nonusers had similar rates of bone loss (1.1% and 0.8%; P = 0.18) and fractures (relative hazard, 1.0 [CI, 0.60 to 1.71).. In this population, warfarin use did not decrease bone mineral density or increase fracture rates.

Topics: Aged; Anticoagulants; Bone Density; Female; Follow-Up Studies; Fractures, Bone; Humans; Osteoporosis, Postmenopausal; Risk Factors; Warfarin

In a prospective nonrandomized study, a protocol was examined for prophylaxis of deep venous thrombosis and pulmonary embolism in patients with operative treatment of acetabular and pelvic fractures. There were 197 patients in the study with 203 fractures, including 148 acetabular and 55 pelvic fractures. There were 2 cases of bilateral acetabular fractures and 4 cases with both acetabular and pelvic fractures. The protocol involved preoperative noninvasive screening of the lower extremities, intraoperative and postoperative use of mechanical antithrombotic devices, and chemical prophylaxis with warfarin for 3 weeks following removal of surgical drains. There were 11 cases (6%) of preoperative deep venous thrombosis detected. There were 6 cases of postoperative deep venous thrombosis and 2 cases of pulmonary embolism. The incidence of postoperative venous thrombosis and pulmonary embolism was 3% and 1%, respectively. The protocol was found to be effective for preoperative detection of venous thrombosis and prevention of deep venous thrombosis and pulmonary embolism in trauma patients with minimal bleeding complications and no morbidity from embolic disease.

Topics: Acetabulum; Adolescent; Adult; Aged; Aged, 80 and over; Bandages; Child; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Pelvic Bones; Postoperative Complications; Postoperative Period; Preoperative Care; Pressure; Prospective Studies; Pulmonary Embolism; Thrombosis; Ultrasonography; Warfarin

This study comprises a series of 35 patients with pelvic or lower extremity fractures requiring surgery who also had a documented significant acute deep venous thrombosis (DVT). The authors treated these with low-dose Coumadin and 36 vena caval filters, which were used prophylactically prior to surgery. The patients received low-dose warfarin after placement of the vena caval filters and were maintained at 1.3-1.5 times the prothrombin control value for 6 weeks to 3 months. In this group of patients, there were no fatal pulmonary emboli and no clinically significant complications from filter placement. There were nine asymptomatic filter complications demonstrated radiographically in eight patients. Additionally, one patient with a tilted vena caval filter required placement of another filter. The combination of vena caval filters and low-dose warfarin appears to be a successful and relatively safe method of managing those patients who have acute DVT and require surgery for their pelvic or lower extremity fractures.

Topics: Combined Modality Therapy; Drug Monitoring; Female; Follow-Up Studies; Fractures, Bone; Humans; Male; Phlebography; Preoperative Care; Prothrombin Time; Thrombophlebitis; Vena Cava Filters; Warfarin

In a retrospective study we collected patient data relating to clinically detected postoperative thromboembolic complications before (n = 1710) and after (n = 2212) adopting a protocol for prophylaxis of deep vein thrombosis (DVT). A relatively low incidence of clinically diagnosed DVT, four per thousand, before systematic instructions for prophylaxis in 1981 could be explained by the frequent use of dextran as a volume expander in critically ill patients. However, following systematic prophylaxis the frequency of DVT decreased further (one per thousand).

Topics: Adolescent; Adult; Aged; Anticoagulants; Bandages; Combined Modality Therapy; Dextrans; Dihydroergotamine; Drug Combinations; Early Ambulation; Female; Fractures, Bone; Heparin; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Multiple Trauma; Postoperative Complications; Pulmonary Embolism; Risk Factors; Thrombophlebitis; Warfarin

Topics: Animals; Bone and Bones; Calcium; Calcium-Binding Proteins; Fractures, Bone; Kinetics; Osteocalcin; Rats; Rats, Inbred Strains; Warfarin; Wound Healing

Topics: Adult; Aged; Contraceptives, Oral; Diagnosis, Differential; Female; Fractures, Bone; Heparin; Humans; Ilium; Male; Middle Aged; Myocardial Infarction; Phlebitis; Phlebography; Pneumonia, Viral; Psittacosis; Pulmonary Embolism; Radionuclide Imaging; Recurrence; Thromboembolism; Warfarin; Wounds and Injuries

Topics: Administration, Oral; Adult; Aged; Follow-Up Studies; Fractures, Bone; Hip; Hip Injuries; Humans; Middle Aged; Phlebography; Postoperative Care; Postoperative Complications; Preoperative Care; Thromboembolism; Time Factors; Warfarin

Topics: Adult; Aged; Anticoagulants; Female; Femoral Fractures; Fractures, Bone; Hemorrhage; Humans; Male; Middle Aged; Pelvic Bones; Postoperative Complications; Spinal Injuries; Thromboembolism; Warfarin

Topics: Anticoagulants; Drug Therapy; Femoral Fractures; Femoral Neck Fractures; Fracture Fixation; Fractures, Bone; Humans; Immobilization; Pelvic Bones; Preventive Medicine; Thromboembolism; Warfarin

Topics: Adolescent; Adult; Animals; Anticoagulants; Blood Coagulation Disorders; Bone Development; Child; Child, Preschool; Female; Fibrin; Fractures, Bone; Fractures, Ununited; Hematoma; Hemophilia A; Heparin; Humans; Infant; Male; Periosteum; Pseudarthrosis; Rabbits; Radiography; Radius Fractures; Warfarin; Wound Healing

Topics: Casts, Surgical; Dicumarol; Femoral Vein; Fracture Fixation; Fractures, Bone; Heparin; Humans; Iliac Vein; Injections, Intravenous; Leg; Leg Injuries; Thrombophlebitis; Warfarin