Key result
Patients taking NOACs prior to hip fracture surgery had significantly higher mean total blood loss (1339 ml) compared to those on warfarin (801 ml), antiplatelets (879 ml), or no anticoagulation (758 ml).
Why the study?
The study was designed to compare hospital outcomes in patients receiving NOACs who underwent hip fracture fixation against those treated with clopidogrel, aspirin, or warfarin.
Do NOACs increase blood loss, transfusion rates, and length of stay in patients undergoing hip fracture surgery compared to warfarin, antiplatelets, or no anticoagulation?
Cohort (n=363)
No
Do NOACs increase blood loss, transfusion rates, and length of stay in patients undergoing hip fracture surgery compared to warfarin, antiplatelets, or no anticoagulation?
p-value: p=<0.001
Patients on NOACs undergoing hip fracture surgery experience greater blood loss, more transfusions, delayed surgery, and longer hospital stays compared to those on warfarin, antiplatelets, or no anticoagulation.
May warrant perioperative caution with NOACs in hip fracture surgery; leaves open need for prospective trials to guide management.
Objective. The purpose of this study is to compare hospital outcomes in patients being treated with NOACs, undergoing fixation of hip fracture, compared to patients treated with clopidogrel, aspirin, or warfarin. Methods. We collected data from 370 patients who underwent hip fracture surgery. The sample was divided into 4 groups: NOACs, warfarin, clopidogrel/aspirin and not taking anticoagulation. We compared outcome measures including time to surgery, length of stay (LOS), transfusion rate, and blood loss. Results. 363 hip fractures met the inclusion criteria. The total blood loss of group 1 (NOACs) was higher compared to the other groups with an increase in the number of red blood cell (RBC) transfused units (p < 0.001). The mean total blood loss of NOACs group was higher in patients undergoing surgery after 48 hours from admission compared to before 48 hours, but not statistically significant (p < 0.483). Group 1 had a time to surgery (p < 0.0005) and LOS (p < 0.0005) greater than the other groups. Conclusions. The time of suspension of NOAC in patients with hip fracture undergoing surgery is important. Failure to understand this parameter puts the patient at risk of a longer hospital stay and greater total blood loss.
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Caternicchia et al. (2020) conducted a cohort in Hip fracture (n=363). NOACs vs. Warfarin, clopidogrel/aspirin, or no anticoagulation was evaluated on Total blood loss (p=<0.001). Patients taking NOACs prior to hip fracture surgery had significantly higher mean total blood loss (1339 ml) compared to those on warfarin (801 ml), antiplatelets (879 ml), or no anticoagulation (758 ml).
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