Effects of Antiplatelet and Anticoagulant Therapy on Emergency Surgical Outcomes in Orthopedic Trauma Patients With Cardiac Comorbidities

BACKGROUND: Emergency orthopedic trauma surgery in patients with cardiac comorbidities presents a major clinical challenge due to the widespread use of antiplatelet and anticoagulant therapy. OBJECTIVE: To evaluate the impact of antiplatelet and anticoagulant therapy on perioperative bleeding, surgical timing, postoperative complications, and mortality in orthopedic trauma patients with cardiac comorbidities. METHODS: This retrospective cross-sectional study was conducted at Jinnah Hospital, Lahore, from June 2024 to June 2025. It included 246 patients with cardiac comorbidities who underwent emergency orthopedic trauma surgery. Emergency surgery was defined as operative fixation required within 72 hours of injury based on pain severity, fracture instability, neurovascular risk, or potential displacement. Data were collected on demographics, comorbidities, type of antithrombotic therapy, fracture patterns, surgical timing, intraoperative blood loss, transfusion requirements, postoperative complications, length of stay, and in-hospital mortality. RESULTS: The mean age of patients was 64.2±11.8 years, with 60.6% being male. Hip fractures were the most common injury (65.8%). Antiplatelet therapy was used in 55.7% of patients, anticoagulants in 31.7%, and combined therapy in 12.6%. Patients on dual antiplatelet therapy and anticoagulants had significantly greater blood loss (742±235 ml and 689±228 ml, respectively) and higher transfusion requirements compared with aspirin-only patients. Surgical delay was longest in patients on direct oral anticoagulants (56.2±14.9 hours). Postoperative complications included wound hematoma (13.8%), infection (7.7%), thromboembolic events (6.9%), and reoperation (4.5%). Overall mortality was 8.5%, highest among patients on dual antiplatelet therapy (11.7%). Logistic regression identified dual antiplatelet therapy (OR 2.4, 95% CI 1.2-4.8), anticoagulant therapy (OR 1.9, 95% CI 1.1-3.6), surgical delay >48 hours (OR 2.8, 95% CI 1.5-5.1), and age >70 years (OR 2.2, 95% CI 1.1-4.3) as independent predictors of adverse outcomes. CONCLUSION: Antiplatelet and anticoagulant therapy significantly influence emergency surgical outcomes in orthopedic trauma patients with cardiac comorbidities. These findings support the need for standardized multidisciplinary perioperative protocols including early cardiology input, structured antithrombotic management pathways, and expedited surgical planning to optimize outcomes in this high-risk population.