Key result
Early hip fracture surgery in patients taking DOACs was not associated with significantly increased blood transfusion rates (51.2% vs 43.5%, P=0.41) or 30-day mortality compared to controls.
Why the study?
To determine how preoperative DOAC use affects rates of blood transfusion, clinically important blood loss, and 30-day mortality in hip fracture patients undergoing surgery within 48 hours of presentation.
Does preoperative DOAC use increase clinically important blood loss or mortality in patients undergoing early hip fracture surgery?
Cohort (n=535)
Yes
Does preoperative DOAC use increase clinically important blood loss or mortality in patients undergoing early hip fracture surgery?
Early hip fracture surgery should not be delayed solely due to a patient taking direct oral anticoagulants, as it does not appear to significantly increase bleeding morbidity.
Answers are grounded in this paper and cite their sources.
Early surgery in DOAC users showed no excess transfusion or mortality; hypothesis-generating and leaves open need for prospective confirmation.
Objectives: To determine how preoperative direct oral anticoagulant (DOAC) use affects rates of blood transfusion, clinically important blood loss, and 30-day mortality in patients with hip fracture undergoing surgery within 48 hours of presentation to the emergency department. Design: Retrospective cohort study. Setting: Academic trauma center. Patients: A total of 535 patients with hip fracture who underwent open cephalomedullary nail fixation or arthroplasty either taking a direct oral anticoagulant or no form of chemical anticoagulant/antiplatelet agent before presentation (control). Main Outcome Measures: Demographics, time to surgery, type of surgery, blood transfusion requirement, clinically important blood loss, and 30-day mortality. Results: Forty-one patients (7.7%) were taking DOACs. DOAC patients were older (81.7 vs. 77 years, P = 0.02) and had higher BMI (26.9 vs. 24.2 kg/m 2 , P = 0.01). Time from admission to surgery was similar between DOAC users (20.1 hours) and the control (18.7 hours, P > 0.4). There was no difference in receipt of blood transfusion ( P = 0.4), major bleeding diagnosis ( P = 0.2), acute blood loss anemia diagnosis ( P = 0.5), and 30-day mortality ( P = 1) between the DOAC and control group. This was true when stratifying by type of surgery as well. Conclusions: Our results suggest that early surgery may be safe in patients with hip fracture taking DOACs despite theoretical risk of increased bleeding. Because early surgery has previously been associated with decreased morbidity and mortality, we suggest that hip fracture surgery should not be delayed because a patient is taking direct oral anticoagulants. Level of Evidence: Prognostic Level III.
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Kolodychuk et al. (2023) conducted a cohort in Hip fracture (n=535). Direct oral anticoagulants (DOAC) vs. No chemical anticoagulant/antiplatelet agent was evaluated on Receipt of blood transfusion (as a marker for clinically important blood loss) (p=0.41). Early hip fracture surgery in patients taking DOACs was not associated with significantly increased blood transfusion rates (51.2% vs 43.5%, P=0.41) or 30-day mortality compared to controls.
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