• Hip fracture patients on warfarin should be booked for a late morning / early afternoon theatre slot to facilitate warfarin reversal.

• INR less than or equal to 1.4 is considered safe for surgery and spinal anaesthesia

• Beriplex use requires authorisation from a Consultant Haematologist

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Abbreviations

• Risk stratify the patient according to their indication for warfarin using the warfarin section of the Haematology and VTE guideline titled “Management of Anticoagulated patients Undergoing Elective Surgery or Invasive Procedures”:

• For low thrombotic risk patients, follow the Warfarin reversal pathway below which is specific for hip fracture patients

• For high thrombotic risk patients, discuss the patient with the Consultant Orthogeriatrician prior to initiating reversal

• Book the patient for the late morning or early afternoon theatre slot to facilitate warfarin reversal

• Patients requiring more urgent surgery (e.g. on the same day as diagnosis) can proceed directly to the Beriplex reversal pathway at the discretion of the orthopaedic and orthogeriatric team

On the morning of surgery

• Ensure the patient is booked for a late morning or early afternoon theatre slot

• Call the on-call Consultant Haematologist via switchboard (from 08:00) to request Beriplex administration approval and advice on dosage. You will need:

  • patient’s weight

  • warfarin dose history

  • INR results

  • vitamin K dose history

• Order Beriplex on EPIC and contact Blood Bank to action request immediately, quoting the Consultant Haematologist’s name (essential for Blood Bank to issue)

1 hour prior to surgery

• Administer Beriplex

15 minutes after administration of Beriplex

• Send INR - contact lab so they will process immediately

• Update operating surgeon, anaesthetist and orthogeriatric team with result:

  • If INR > 1.4 - contact on-call consultant haematologist for advice

  • If INR ≤ 1.4 - ready for surgery

Postoperative recommencement of warfarin

• For postoperative restarting of warfarin and bridging therapy, refer to the warfarin section of the Haematology and VTE guideline Management of Anticoagulated Patients Undergoing Elective Surgery or Invasive Procedures.

Association of Anaesthetists (2020) Management of hip fractures 2020. Available at: https://anaesthetists.org/Home/Resources-publications/Guidelines/Management-of-hip-fractures-2020 (Accessed: 28 October 2024).

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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