Prevalence of vitamin K deficiency in older people with hip fracture.

Introduction: Vitamin K plays an important role in blood coagulation. Diet is the main source of vitamin K and body stores are depleted in days, hence deficiency is common in malnourished older people. A high proportion of people who sustain a hip fracture are already malnourished, compounded by fasting for surgery which might further increase deficiency. We wanted to explore the prevalence of vitamin K deficiency in hip fracture patients and the impact of a short period of fasting.Methods: In consecutive patients hospitalised with a hip fracture, we measured vitamin K and PIVKA-II (undercarboxylated factor II - a marker of subclinical vitamin K status) on admission and on first post-operative day. We excluded those on anticoagulants.Results: N = 62 participated; 4 had missing pre-op vitamin K samples and n = 3 had no surgery leaving n = 55 with paired samples. Mean age was 80.0 ± 9.6 years, 33% males. Prevalence of subclinical vitamin K deficiency on admission was 36% (20/55) based on reference range of > 0.15µg/L. The proportion with subclinical K deficiency after surgery rose to 64% (35/55), p < 0.05. 13% had detectable PIVKA-II concentrations pre-operatively, 15% did post-operatively. None had abnormal prothrombin time. Vitamin K status was not associated with post-operative haemoglobin drop or transfusion requirements.Conclusion: Prevalence of vitamin K deficiency in hip fracture patients is high and increases further following a short period of fasting. Though no significant impact was noted on peri-operative blood loss, larger studies are warranted to explore this, and the potential role of vitamin K supplements peri-operatively.

[Traumatic aorto-caval fistula (author's transl)]. / Traumatische Aorta-Kava-Fistel.

A 33-year-old man sustained a thoracoabdominal bullet injury discovered on exploration to have tears in the liver and perforation in the stomach. Two months later admitted for bilateral serosanguinous pleural effusion, hypertension, heart failure and continuous murmur heard at the right hypochondrium. Aortogram showed aorto-caval fistula at the site of the injured right renal artery and a non-functioning right kidney. Successful external obliteration technique of the fistula had to be performed because of the heavy adhesions encountered, together with right sided nephrectomy. Two other alternative methods of treatment were suggested namely the application of profound hypothermia and circulatory arrest or the use of the aortic compressors and open fistulectomy.