OBJECTIVES: There are 6,000 hip fractures annually in Finland with a population of 5.4 million. These elderly patients (average 80y) almost always require surgery. Among elderly, 14% are using warfarin, and the anticoagulation effect should be reversed prior to surgery. The four approaches commonly used are: cessation of warfarin therapy, administration of vitamin-K, Fresh Frozen Plasma (FFP) or Prothrombin Complex Concentrate (PCC). These approaches have different onset times and thus, the choice of the method used influences the delay before the surgery can safely be performed. Delay of the operation increases the number of preoperative hospital days, and is associated with increased mortality. PCC acts as an antidote, and thus enables immediate operation. METHODS: There were 232 patients with acute hip fracture in Kuopio University Hospital (KUH) in 2009 with a 30 days mortality of 18 patients and delay of 16 operations. Patients in need for warfarin reversal were estimated, as well as additional hospital days caused by the possible delay of surgery. Medication, laboratory costs, and cost of hospitalization due to the delay were estimated for a one year perspective. Mortality rate w/wo delay was estimated. RESULTS: There were estimated to be 29 patients with acute hip fracture requiring warfarin reversal in KUH annually. Among these patients, the reversal of anticoagulation with FPP, vitamin K, or cessation of warfarin leads to 30, 30 and  116 additional hospital days per year compared to PCC. The total costs were 22 700€, 10200 €, 156 900€ and 20 300€ with FFP, vitamin-K, cessation of warfarin and PCC, respectively. Mortality rate was estimated to be 10.6% and 7.5% w/wo delay, respectively. CONCLUSIONS: Delay of the acute surgical intervention increases healthcare costs. The use of antidote (PCC) decreases this delay among warfarin users, and may lead to cost savings and decrease in mortality.