Study Finds, INR Thresholds for Complications in Hip Fractur
A Study was conducted to examine the association of (1) preoperative International Normalized Ratio (INR) values and (2) surgical delay with postoperative complications after intramedullary nailing of hip fractures. In hip fracture patients with elevated international normalized ratios (INRs), the risks of delaying surgery for correction of INR are controversial.

Patients aged older than 55 years with preoperative INR recorded less than 1 day before surgery were included. The primary outcomes of interest were postoperative bleeding requiring transfusion, surgical site infection, and 30-day mortality.

--In total, 15,323 patients were included in this study.

--Adjusting for potential confounders, INR [1 to 1.25], INR [1.25 to 1.5], and INR [1.5 to 2.0] were associated with increased mortality and surgical delay more than 48 hours.

--The INR more than 2.0 cohort was not associated with mortality or surgical delay.

--Surgical delay was associated with mortality.

--The INR more than 2.0 cohort was associated with increased rate of transfusions.

Conclusively, an increased risk of 30-day mortality and surgery delay more than 48 hours, which may represent attempts at INR correction, were linked to the increasing INR preoperative value within 1 day of the surgery, from 1.0 to 2.0. An INR larger than 2.0 was not related to death or surgical delay but to increasing transfusions. Independent of the surgical delay, the probability of 30-day lifetime was raised.