Effect of Prothrombin Complex Concentrates on Time to Surgery in Patients with Hip Fracture Anticoagulated with Vitamin K Antagonists
Bibliographic record
Abstract
Objectives: To determine the time to surgery (TTS) among patients with acute hip fracture who are anticoagulated with vitamin K antagonists (VKAs) who receive prothrombic complex concentrate (PCC) compared to those who do not receive PCC. Method: We conducted a retrospective cohort study of consecutive patients with an acute hip fracture presenting to the emergency department (ED) of the Jewish General Hospital, a 637-bed tertiary care hospital center in Montreal, Quebec, between January 1st, 2015 and March 1st, 2020. Eligible patients were identified via the ED electronic database. Inclusion criteria were: (1) > 18 years of age; (2) acute hip fracture and admission for surgical repair; (3) VKA use and international normalized ratio (INR) > 1.5 at admission. Follow-up was limited to index hospitalization. The primary outcome of TTS, reported in hours, was defined as the time from hospital admission to the time of surgery. Mann-Whitney U test was used to assess any difference in median TTS between the two groups. Results: A total of 53 patients were included in our cohort of which 43.4% (23/53) received PCC with a median time to first dose of 25.5 hours (IQR 19.4-51.6). 84.9 % (45/53) received vitamin K with a median time to the first dose of 16 h (IQR 7.5-26.7). The median TTS in the PCC and no PCC groups was 51.8 h (IQR 26.8–71.4) vs. 63.5 h (IQR 49.4-73.2) respectively (p=0.71). Conclusion: This study did not identify shorter TTS between patients who received PCC and those who did not. Median TTS in both groups surpassed the recommended 48h benchmark, and PCC and vitamin K administration timing was suboptimal. These findings demonstrate a significant care gap among this vulnerable population and represent a call for future initiatives to ensure a more streamlined and multidisciplinary approach to anticoagulation management starting at the onset of presentation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".