Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?
Background Patients sustaining a fractured neck of the femur are typically of advanced age with multiple comorbidities. As a consequence, the proportion of these patients receiving warfarin therapy is approximately 10%. There are currently few studies investigating outcomes in this subset of patient...
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| Veröffentlicht in: | Clinical orthopaedics and related research 2017-01, Vol.475 (1), p.273-279 |
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| creator | Lawrence, John E. Fountain, Daniel M. Cundall-Curry, Duncan J. Carrothers, Andrew D. |
| description | Background
Patients sustaining a fractured neck of the femur are typically of advanced age with multiple comorbidities. As a consequence, the proportion of these patients receiving warfarin therapy is approximately 10%. There are currently few studies investigating outcomes in this subset of patients.
Questions/purposes
The purpose of this study was to assess the association between warfarin therapy and time to surgery, length of hospital stay, and survival in patients sustaining a fractured neck of the femur.
Methods
Data for 2036 patients admitted to our center between July 2009 and July 2014 with a fractured neck of the femur were extracted from the National Hip Fracture Database. Fifty-seven patients received no surgical treatment and were excluded from analysis. Multivariable ordinary least squares regression was performed to test the association between warfarin treatment on time to surgery and length of stay, and Cox proportional hazards to test followup survival. Variables included in the regression model were age, sex, American Society of Anesthesiologists (ASA) score, admission Abbreviated Mental Test Score (AMTS), fracture type, operation type, and premorbid Work Ability Index (WAI). One hundred fifty-two of 1979 surgically treated patients (8%) were receiving warfarin therapy at the time of admission.
Results
After controlling for age, sex, ASA score, AMTS, fracture type, operation type, and WAI, we found that patients taking warfarin were less likely to go to surgery by 36 hours (odds ratio [OR], 0.20; 95% CI, 0.14–0.30), and less likely to go to surgery by 48 hours (OR, 0.17; 95% CI, 0.11–0.24). Patients taking warfarin had a longer length of stay (median, 15 days; interquartile range [IQR], 12–22 days) compared with patients not taking warfarin (median, 13 days; IQR, 9–20 days; p < 0.001). Survival analysis to June 2015 showed a higher mortality for patients taking warfarin (12-month survival, 66% vs 76%; hazard ratio, 1.57; 95% CI, 1.21–2.04; p < 0.001).
Conclusions
After controlling for multiple prognostic factors such as age, ASA score, AMTS, and WAI, warfarin therapy at the time of injury is associated with increased time to surgery, length of stay, and decreased survival. This study highlights the need to view warfarin therapy as a ‘red flag’ in patients presenting with a fractured neck of the femur. Preoperatively, prompt warfarin reversal together with adequate investigation and optimization of the patient should ensure timely, safe s |
| doi_str_mv | 10.1007/s11999-016-5056-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5174047</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1859495883</sourcerecordid><originalsourceid>FETCH-LOGICAL-c503t-c45e7f9fa16d479a9cb5811c5d8acaa989f96e11e5fcb70794aafaded7be81703</originalsourceid><addsrcrecordid>eNqNkl9rFDEUxYModq1-AF8k4IsPHc2dnUySF0vpHyssWOiKvoW7mcw2dXYyJpnV_fZm2FqqIPgUwvnlJCf3EPIS2FtgTLyLAEqpgkFdcMbrgj0iM-ClLADm5WMyY4ypQpXw9YA8i_E2b-cVL5-Sg1JwWdecz8iPM0-vMDnbp0iX-M31a_oFQ4vB9fT852BDloylZ7bDXaTJ0-WNxRTsEV34fm0DvfRxcAk7ep1wd0Sxb-iV9yEr12PYum1WTto0gW6gFwFNGoM9fk6etNhF--JuPSSfL86Xp5fF4tOHj6cni8JwNk-FqbgVrWoR6qYSCpVZcQlgeCPRICqpWlVbAMtbsxJMqAqxxcY2YmUlCDY_JO_3vsO42tjG5JwBOz0Et8Gw0x6d_lPp3Y1e-63mICpWiWzw5s4g-O-jjUlvXDS267C3fowaJFeV4lLO_weFUoBiZUZf_4Xe-jH0-ScmitWqrITMFOwpE3yMwbb37wampwbofQN0boCeGqCnwK8eBr4_8XvkGSj3QMzSNMEHV__T9RcS_700</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1850692478</pqid></control><display><type>article</type><title>Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Lawrence, John E. ; Fountain, Daniel M. ; Cundall-Curry, Duncan J. ; Carrothers, Andrew D.</creator><creatorcontrib>Lawrence, John E. ; Fountain, Daniel M. ; Cundall-Curry, Duncan J. ; Carrothers, Andrew D.</creatorcontrib><description>Background
Patients sustaining a fractured neck of the femur are typically of advanced age with multiple comorbidities. As a consequence, the proportion of these patients receiving warfarin therapy is approximately 10%. There are currently few studies investigating outcomes in this subset of patients.
Questions/purposes
The purpose of this study was to assess the association between warfarin therapy and time to surgery, length of hospital stay, and survival in patients sustaining a fractured neck of the femur.
Methods
Data for 2036 patients admitted to our center between July 2009 and July 2014 with a fractured neck of the femur were extracted from the National Hip Fracture Database. Fifty-seven patients received no surgical treatment and were excluded from analysis. Multivariable ordinary least squares regression was performed to test the association between warfarin treatment on time to surgery and length of stay, and Cox proportional hazards to test followup survival. Variables included in the regression model were age, sex, American Society of Anesthesiologists (ASA) score, admission Abbreviated Mental Test Score (AMTS), fracture type, operation type, and premorbid Work Ability Index (WAI). One hundred fifty-two of 1979 surgically treated patients (8%) were receiving warfarin therapy at the time of admission.
Results
After controlling for age, sex, ASA score, AMTS, fracture type, operation type, and WAI, we found that patients taking warfarin were less likely to go to surgery by 36 hours (odds ratio [OR], 0.20; 95% CI, 0.14–0.30), and less likely to go to surgery by 48 hours (OR, 0.17; 95% CI, 0.11–0.24). Patients taking warfarin had a longer length of stay (median, 15 days; interquartile range [IQR], 12–22 days) compared with patients not taking warfarin (median, 13 days; IQR, 9–20 days; p < 0.001). Survival analysis to June 2015 showed a higher mortality for patients taking warfarin (12-month survival, 66% vs 76%; hazard ratio, 1.57; 95% CI, 1.21–2.04; p < 0.001).
Conclusions
After controlling for multiple prognostic factors such as age, ASA score, AMTS, and WAI, warfarin therapy at the time of injury is associated with increased time to surgery, length of stay, and decreased survival. This study highlights the need to view warfarin therapy as a ‘red flag’ in patients presenting with a fractured neck of the femur. Preoperatively, prompt warfarin reversal together with adequate investigation and optimization of the patient should ensure timely, safe surgery. Early involvement of the anesthesia team should ensure an appropriate level of postoperative care for these patients.
Level of Evidence
Level III, therapeutic study</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1007/s11999-016-5056-0</identifier><identifier>PMID: 27586655</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aged ; Aged, 80 and over ; Anticoagulants - therapeutic use ; Clinical Research ; Conservative Orthopedics ; Female ; Femoral Neck Fractures - mortality ; Femoral Neck Fractures - surgery ; Humans ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Models, Theoretical ; Orthopedics ; Retrospective Studies ; Risk Factors ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Survival Rate ; Time Factors ; Time-to-Treatment ; Trauma ; Treatment Outcome ; Warfarin - therapeutic use</subject><ispartof>Clinical orthopaedics and related research, 2017-01, Vol.475 (1), p.273-279</ispartof><rights>The Author(s) 2016</rights><rights>Clinical Orthopaedics and Related Research is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-c45e7f9fa16d479a9cb5811c5d8acaa989f96e11e5fcb70794aafaded7be81703</citedby><cites>FETCH-LOGICAL-c503t-c45e7f9fa16d479a9cb5811c5d8acaa989f96e11e5fcb70794aafaded7be81703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174047/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174047/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,882,27905,27906,41469,42538,51300,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27586655$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lawrence, John E.</creatorcontrib><creatorcontrib>Fountain, Daniel M.</creatorcontrib><creatorcontrib>Cundall-Curry, Duncan J.</creatorcontrib><creatorcontrib>Carrothers, Andrew D.</creatorcontrib><title>Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><addtitle>Clin Orthop Relat Res</addtitle><description>Background
Patients sustaining a fractured neck of the femur are typically of advanced age with multiple comorbidities. As a consequence, the proportion of these patients receiving warfarin therapy is approximately 10%. There are currently few studies investigating outcomes in this subset of patients.
Questions/purposes
The purpose of this study was to assess the association between warfarin therapy and time to surgery, length of hospital stay, and survival in patients sustaining a fractured neck of the femur.
Methods
Data for 2036 patients admitted to our center between July 2009 and July 2014 with a fractured neck of the femur were extracted from the National Hip Fracture Database. Fifty-seven patients received no surgical treatment and were excluded from analysis. Multivariable ordinary least squares regression was performed to test the association between warfarin treatment on time to surgery and length of stay, and Cox proportional hazards to test followup survival. Variables included in the regression model were age, sex, American Society of Anesthesiologists (ASA) score, admission Abbreviated Mental Test Score (AMTS), fracture type, operation type, and premorbid Work Ability Index (WAI). One hundred fifty-two of 1979 surgically treated patients (8%) were receiving warfarin therapy at the time of admission.
Results
After controlling for age, sex, ASA score, AMTS, fracture type, operation type, and WAI, we found that patients taking warfarin were less likely to go to surgery by 36 hours (odds ratio [OR], 0.20; 95% CI, 0.14–0.30), and less likely to go to surgery by 48 hours (OR, 0.17; 95% CI, 0.11–0.24). Patients taking warfarin had a longer length of stay (median, 15 days; interquartile range [IQR], 12–22 days) compared with patients not taking warfarin (median, 13 days; IQR, 9–20 days; p < 0.001). Survival analysis to June 2015 showed a higher mortality for patients taking warfarin (12-month survival, 66% vs 76%; hazard ratio, 1.57; 95% CI, 1.21–2.04; p < 0.001).
Conclusions
After controlling for multiple prognostic factors such as age, ASA score, AMTS, and WAI, warfarin therapy at the time of injury is associated with increased time to surgery, length of stay, and decreased survival. This study highlights the need to view warfarin therapy as a ‘red flag’ in patients presenting with a fractured neck of the femur. Preoperatively, prompt warfarin reversal together with adequate investigation and optimization of the patient should ensure timely, safe surgery. Early involvement of the anesthesia team should ensure an appropriate level of postoperative care for these patients.
Level of Evidence
Level III, therapeutic study</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - therapeutic use</subject><subject>Clinical Research</subject><subject>Conservative Orthopedics</subject><subject>Female</subject><subject>Femoral Neck Fractures - mortality</subject><subject>Femoral Neck Fractures - surgery</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Models, Theoretical</subject><subject>Orthopedics</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Time-to-Treatment</subject><subject>Trauma</subject><subject>Treatment Outcome</subject><subject>Warfarin - therapeutic use</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkl9rFDEUxYModq1-AF8k4IsPHc2dnUySF0vpHyssWOiKvoW7mcw2dXYyJpnV_fZm2FqqIPgUwvnlJCf3EPIS2FtgTLyLAEqpgkFdcMbrgj0iM-ClLADm5WMyY4ypQpXw9YA8i_E2b-cVL5-Sg1JwWdecz8iPM0-vMDnbp0iX-M31a_oFQ4vB9fT852BDloylZ7bDXaTJ0-WNxRTsEV34fm0DvfRxcAk7ep1wd0Sxb-iV9yEr12PYum1WTto0gW6gFwFNGoM9fk6etNhF--JuPSSfL86Xp5fF4tOHj6cni8JwNk-FqbgVrWoR6qYSCpVZcQlgeCPRICqpWlVbAMtbsxJMqAqxxcY2YmUlCDY_JO_3vsO42tjG5JwBOz0Et8Gw0x6d_lPp3Y1e-63mICpWiWzw5s4g-O-jjUlvXDS267C3fowaJFeV4lLO_weFUoBiZUZf_4Xe-jH0-ScmitWqrITMFOwpE3yMwbb37wampwbofQN0boCeGqCnwK8eBr4_8XvkGSj3QMzSNMEHV__T9RcS_700</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Lawrence, John E.</creator><creator>Fountain, Daniel M.</creator><creator>Cundall-Curry, Duncan J.</creator><creator>Carrothers, Andrew D.</creator><general>Springer US</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170101</creationdate><title>Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?</title><author>Lawrence, John E. ; Fountain, Daniel M. ; Cundall-Curry, Duncan J. ; Carrothers, Andrew D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c503t-c45e7f9fa16d479a9cb5811c5d8acaa989f96e11e5fcb70794aafaded7be81703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants - therapeutic use</topic><topic>Clinical Research</topic><topic>Conservative Orthopedics</topic><topic>Female</topic><topic>Femoral Neck Fractures - mortality</topic><topic>Femoral Neck Fractures - surgery</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Models, Theoretical</topic><topic>Orthopedics</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Time-to-Treatment</topic><topic>Trauma</topic><topic>Treatment Outcome</topic><topic>Warfarin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lawrence, John E.</creatorcontrib><creatorcontrib>Fountain, Daniel M.</creatorcontrib><creatorcontrib>Cundall-Curry, Duncan J.</creatorcontrib><creatorcontrib>Carrothers, Andrew D.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lawrence, John E.</au><au>Fountain, Daniel M.</au><au>Cundall-Curry, Duncan J.</au><au>Carrothers, Andrew D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?</atitle><jtitle>Clinical orthopaedics and related research</jtitle><stitle>Clin Orthop Relat Res</stitle><addtitle>Clin Orthop Relat Res</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>475</volume><issue>1</issue><spage>273</spage><epage>279</epage><pages>273-279</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>Background
Patients sustaining a fractured neck of the femur are typically of advanced age with multiple comorbidities. As a consequence, the proportion of these patients receiving warfarin therapy is approximately 10%. There are currently few studies investigating outcomes in this subset of patients.
Questions/purposes
The purpose of this study was to assess the association between warfarin therapy and time to surgery, length of hospital stay, and survival in patients sustaining a fractured neck of the femur.
Methods
Data for 2036 patients admitted to our center between July 2009 and July 2014 with a fractured neck of the femur were extracted from the National Hip Fracture Database. Fifty-seven patients received no surgical treatment and were excluded from analysis. Multivariable ordinary least squares regression was performed to test the association between warfarin treatment on time to surgery and length of stay, and Cox proportional hazards to test followup survival. Variables included in the regression model were age, sex, American Society of Anesthesiologists (ASA) score, admission Abbreviated Mental Test Score (AMTS), fracture type, operation type, and premorbid Work Ability Index (WAI). One hundred fifty-two of 1979 surgically treated patients (8%) were receiving warfarin therapy at the time of admission.
Results
After controlling for age, sex, ASA score, AMTS, fracture type, operation type, and WAI, we found that patients taking warfarin were less likely to go to surgery by 36 hours (odds ratio [OR], 0.20; 95% CI, 0.14–0.30), and less likely to go to surgery by 48 hours (OR, 0.17; 95% CI, 0.11–0.24). Patients taking warfarin had a longer length of stay (median, 15 days; interquartile range [IQR], 12–22 days) compared with patients not taking warfarin (median, 13 days; IQR, 9–20 days; p < 0.001). Survival analysis to June 2015 showed a higher mortality for patients taking warfarin (12-month survival, 66% vs 76%; hazard ratio, 1.57; 95% CI, 1.21–2.04; p < 0.001).
Conclusions
After controlling for multiple prognostic factors such as age, ASA score, AMTS, and WAI, warfarin therapy at the time of injury is associated with increased time to surgery, length of stay, and decreased survival. This study highlights the need to view warfarin therapy as a ‘red flag’ in patients presenting with a fractured neck of the femur. Preoperatively, prompt warfarin reversal together with adequate investigation and optimization of the patient should ensure timely, safe surgery. Early involvement of the anesthesia team should ensure an appropriate level of postoperative care for these patients.
Level of Evidence
Level III, therapeutic study</abstract><cop>New York</cop><pub>Springer US</pub><pmid>27586655</pmid><doi>10.1007/s11999-016-5056-0</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0009-921X |
| ispartof | Clinical orthopaedics and related research, 2017-01, Vol.475 (1), p.273-279 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Aged Aged, 80 and over Anticoagulants - therapeutic use Clinical Research Conservative Orthopedics Female Femoral Neck Fractures - mortality Femoral Neck Fractures - surgery Humans Length of Stay Male Medicine Medicine & Public Health Models, Theoretical Orthopedics Retrospective Studies Risk Factors Sports Medicine Surgery Surgical Orthopedics Survival Rate Time Factors Time-to-Treatment Trauma Treatment Outcome Warfarin - therapeutic use |
| title | Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture? |
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