Key result
DOACs are linked to an ~8-hour surgical delay in geriatric hip fractures without increasing mortality.
Why the study?
The study evaluated potential differences in time to surgery, bleeding risk, wound complications, length of stay, transfusion rate, and 30-day mortality between patients on DOACs and those not anticoagulated presenting with acute hip fractures.
Does DOAC therapy at the time of injury increase short-term complications or mortality rates in patients 65 years and older undergoing operative treatment for hip fracture?
Cohort (n=144)
No
Does DOAC therapy at the time of injury increase short-term complications or mortality rates in patients 65 years and older undergoing operative treatment for hip fracture?
Expedited surgery within 48 hours appears safe for geriatric hip fracture patients on DOAC therapies, with no increase in short-term complications or mortality.
Answers are grounded in this paper and cite their sources.
May support expedited surgery despite DOAC use; leaves open need for randomized confirmation.
Objectives: The purpose of this study was to evaluate potential differences in time to surgery, bleeding risk, wound complications, length of stay, transfusion rate, and 30-day mortality between patients anticoagulated with direct oral anticoagulants (DOACs) and those not anticoagulated at the time of evaluation for an acute hip fracture. Design: Retrospective chart review Level III Study. Setting: One university-based hospital in Rochester, NY. Patients/Intervention : Patients 65 years and older undergoing operative treatment of a hip fracture over a 5-year period. Chart review identified patients on DOAC therapy at the time of injury as well as an age and sex-matched control group not on anticoagulation. Main outcome measurements : Demographics, procedure type, admission/postoperative laboratory work, perioperative metrics, transfusion metrics, discharge course, reoperation, readmission, wound complications, and 30-day mortality were obtained for comparison. Results: Thirty-six hip fractures anticoagulated on DOACs were compared to 108 controls. The DOAC group had delays to operative treatment (27.6 h, SD 16.3 h, 95% CL [22.0–33.1]) vs the control group (19.8 h, SD 10.5 h, 95% CL [17.7–21.8], P = .01). No differences were found in estimated blood loss, procedure time, or change in hemoglobin. Transfusion rates were not significantly different between groups (58.3% DOAC vs 47.2% control, P = .25). No difference in reoperation, readmission, wound complication, deep venous thrombosis rates, or 30-day mortality rates were found. Conclusion: Patients presenting on DOAC therapy at the time of hip fracture have a delay to surgery compared with age and sex-matched controls, but no increase in short term complications or mortality rates. Expedited surgery (within 48 h) appeared to be safe and effective treatment for hip fracture patients on DOAC therapies.
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Brown et al. (2020) conducted a cohort in Geriatric hip fracture (n=144). Direct oral anticoagulants (DOACs) vs. No anticoagulation was evaluated on Time to surgery (hours) (p=.01). Direct oral anticoagulant use in geriatric hip fracture patients delayed surgery compared to controls, but did not increase short-term complications or 30-day mortality.
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