Perioperative Anesthesia Management for Hip Fracture Surgery in Elderly Patients on Antithrombotic Therapy

Abstract

Hip fractures in elderly patients are a significant health concern due to their association with increased morbidity, mortality, and reduced quality of life. Early surgical management of patients suffering from hip fractures remains an important means to reduce mortality. Many of these patients are on antithrombotic therapy (anticoagulants or antiplatelets) for underlying comorbidities, posing challenges for perioperative anesthesia management. Discussions are ongoing regarding the optimal mode of anesthesia - regional vs general, with regional having a slight upper hand over general. Ideally, specific time intervals which vary according the type and dose of agents and renal function, related to the administration of antithrombotic drugs both prior to and after neuraxial procedures should be observed. Drug assays may be used to guide individual time intervals. A thorough preoperative assessment including patient history, assessment of underlying comorbidity, laboratory investigations, and assessment of bleeding risk, is important. Interdisciplinary collaboration among anesthesiologists, surgeons, and other specialists is essential for optimal outcomes. In high risk patients, the reversal of antithrombotic agents may be considered taking into consideration of the risk of thrombosis. Where interrupting antithrombotic therapy poses a greater risk, a shorter antithrombotic-free interval may be preferred and deviating from guidelines after multidisciplinary discussion and individual risk-benefit analysis may be considered.

Keywords: Hip fracture surgery, elderly, antithrombotic therapy, general anaethesia, regional anesthesia, early surgery