Key result
Canadian orthopedic surgeons were significantly more likely to advocate for immediate surgery for hip fracture patients taking warfarin (42.9%) compared to those taking a direct oral anticoagulant (23.3%).
Why the study?
DOACs are replacing warfarin but can complicate bleeding during emergent hip fracture surgery, where clear guidelines for surgical timing are lacking.
Cross-Sectional (n=280)
Absolute Event Rate: 42.9% vs 23.3%
p-value: p=<0.001
There is wide variability and a tendency toward delaying surgery among Canadian orthopedic surgeons managing hip fracture patients on DOACs compared to those on warfarin.
May influence hip fracture timing decisions; leaves open need for DOAC-specific reversal evidence before practice change.
Background: Direct oral anticoagulants (DOACs) are rapidly replacing warfarin for therapeutic anticoagulation; however, many DOACs are irreversible and may complicate bleeding in emergent situations such as hip fracture. In this setting, there is a lack of clear guidelines for the timing of surgery. The purpose of this study was to evaluate the current practices of Canadian orthopedic surgeons who manage patients with hip fracture receiving anticoagulation. Methods: In January–March 2018, we administered a purpose-specific cross-sectional survey to all currently practising orthopedic surgeons in Canada who had performed hip fracture surgery in 2017. The survey evaluated approaches to decision-making and timing of surgery in patients with hip fracture receiving anticoagulation. Results: A total of 280 surgeons representing a mix of academic and community practice, seniority and fellowship training responded. Nearly one-quarter of respondents (66 [23.4%]) were members of the Canadian Orthopaedic Trauma Society (COTS). Almost three-quarters (206 [73.6%]) felt that adequate clinical guidelines for patients with hip fracture receiving anticoagulation did not exist, and 177 (61.9%) indicated that anesthesiology or internal medicine had a greater influence on the timing of surgery than the attending surgeon. A total of 117/273 respondents (42.9%) indicated that patients taking warfarin should have immediate surgery (with or without reversal), compared to 63/270 (23.3%) for patients taking a DOAC (p < 0.001). Members of COTS were more likely than nonmembers to advocate for immediate surgery in all patients (p < 0.05). Conclusion: There is wide variability in Canada in the management of patients with hip fracture receiving anticoagulation. Improved multidisciplinary communication, prospectively evaluated treatment guidelines and focus on knowledge translation may add clarity to this issue. Level of evidence: IV.
No takes yet. Share an insight, caveat, or question.
White et al. (2021) conducted a cross-sectional in Orthopedic surgeons managing hip fracture patients receiving anticoagulation (n=280). Patient taking warfarin vs. Patient taking a DOAC was evaluated on Advocating for immediate surgery (p=<0.001). Canadian orthopedic surgeons were significantly more likely to advocate for immediate surgery for hip fracture patients taking warfarin (42.9%) compared to those taking a direct oral anticoagulant (23.3%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: