Key result
DOAC use (11%) and VKA use (9.2%) in geriatric hip fractures were associated with increased time-to-surgery versus no anticoagulation, with no difference in complications or mortality.
Why the study?
The impact of direct oral anticoagulant treatment on perioperative management in hip fracture patients was limited despite increasing DOAC prevalence.
Does DOAC treatment affect time-to-surgery and complications in geriatric hip fracture patients compared to VKA or no anticoagulation?
Observational (n=15,099)
Yes
Does DOAC treatment affect time-to-surgery and complications in geriatric hip fracture patients compared to VKA or no anticoagulation?
Geriatric hip fracture patients on DOACs experience similar surgical delays and complication rates as those on VKAs, suggesting safe perioperative management is feasible.
Supports comparable perioperative risks with DOACs and VKAs in hip fracture patients; leaves open need for randomized confirmation.
Background and Objectives: The increased use of direct oral anticoagulants (DOACs) results in an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC treatment on perioperative management of hip fracture patients is limited. In this study, we describe the prevalence of DOAC treatment in a population of hip fracture patients and compare these patients with patients taking vitamin K antagonists (VKA) and patients not taking anticoagulants. Materials and Methods: This study is a retrospective analysis from the Registry for Geriatric Trauma (ATR-DGU). The data were collected prospectively from patients with proximal femur fractures treated between January 2016 and December 2018. Among other factors, anticoagulation was surveyed. The primary outcome parameter was time-to-surgery. Further parameters were: type of anesthesia, surgical complications, soft tissue complications, length of stay and mortality. Results: In total, 11% (n = 1595) of patients took DOACs at the time of fracture, whereas 9.2% (n = 1325) were on VKA therapy. During the study period, there was a shift from VKA to DOACs. The time-to-surgery of patients on DOACs and of patients on VKA was longer compared to patients who did not take any anticoagulation. No significant differences with regard to complications, type of anesthesia and mortality were found between patients on DOACs compared to VKA treatment. Conclusion: An increased time-to-surgery in patients taking DOACs and taking VKA compared to non-anticoagulated patients was found. This underlines the need for standardized multi-disciplinary orthopedic, hematologic and ortho-geriatric algorithms for the management of hip fracture patients under DOAC treatment. In addition, no significant differences regarding complications and mortality were found between DOAC and VKA users. This demonstrates that even in the absence of widely available antidotes, the safe management of geriatric patients under DOACs with proximal femur fractures is possible.
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Aigner et al. (2022) conducted an observational in Geriatric hip fracture (n=15,099). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKA) and no anticoagulation was evaluated on time-to-surgery. DOAC use (11%) and VKA use (9.2%) in geriatric hip fractures were associated with increased time-to-surgery versus no anticoagulation, with no difference in complications or mortality.
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