Key result
Pre-operative use of direct oral anticoagulants in patients with a hip fracture was associated with a longer time to surgery in 57.1% of studies, but did not increase mortality, blood loss, or complication rates.
Why the study?
The study was conducted to synthesise the evidence on the impact of pre-operative direct oral anticoagulants on health outcomes for patients who sustain a hip fracture.
Does pre-operative DOAC use impact health outcomes in patients with a hip fracture?
Systematic Review
Does pre-operative DOAC use impact health outcomes in patients with a hip fracture?
Pre-operative DOAC use in hip fracture patients is associated with delayed surgery but does not appear to increase mortality, bleeding, or other major complications.
Answers are grounded in this paper and cite their sources.
Supports avoiding unnecessary DOAC-related delays for hip fracture surgery; leaves open need for randomized confirmation.
PURPOSE: To synthesise the evidence on the impact of pre-operative direct oral anticoagulants (DOACs) on health outcomes for patients who sustain a hip fracture. METHOD: A rapid systematic review of three databases (MEDLINE, Embase and Scopus) for English-language articles from January 2000 to August 2021 was conducted. Abstracts and full text were screened by two reviewers and articles were critically appraised. Data synthesis was undertaken to summarise health outcomes examined for DOAC users versus a no anticoagulant group. Key information was extracted for study type, country and time frame, population and sample size, type of DOACs, comparator population(s), key definitions, health outcome(s), and summary study findings. RESULTS: There were 21 articles identified. Of the 18 studies that examined time to surgery, 12 (57.1%) found DOAC users had a longer time to surgery than individuals not using anticoagulants. Five (83.3%) of six studies identified that DOAC users had a lower proportion of surgery conducted within 48 h Four (40.0%) of ten studies reporting hospital length of stay (LOS) identified a higher LOS for DOAC users. Where reported, DOAC users did not have increased mortality, blood loss, transfusion rates, complication rates of stroke, re-operation or readmissions compared to individuals not using anticoagulants. CONCLUSIONS: The effect of DOAC use on hip fracture patient health was mixed, although patients on DOACs had a longer time to surgery. The review highlights the need for consistent measurement of health outcomes in patients with a hip fracture to determine the most appropriate management of patients with a hip fracture taking DOACs.
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Mitchell et al. (2022) conducted a systematic review in Hip fracture. Pre-operative direct oral anticoagulants (DOACs) vs. No anticoagulants was evaluated on Time to surgery. Pre-operative use of direct oral anticoagulants in patients with a hip fracture was associated with a longer time to surgery in 57.1% of studies, but did not increase mortality, blood loss, or complication rates.
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