Comparing the post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants: a meta-analysis

BACKGROUND: Hip fracture in the elderly is considered a significant public health burden due to a high rate of mortality and this is globally being seen as a serious concern. However, comorbidities requiring anticoagulants are of particular concern in the post-operative setting. In this analysis, we aimed to systematically compare the post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants (NOACs). METHODS: Web of Science, EMBASE, Google Scholar, the Cochrane databases, MEDLINE, and http://www. CLINICALTRIALS: gov were searched for relevant studies from January to February 2024. The post-operative complications were considered the endpoints in this study. Risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the data following statistical analysis. Weighted mean difference (WMD) calculated with mean and standard deviation, with 95% CIs, was used to represent the result for mean length of hospital stay. RESULTS: A total number of 15,019 participants with hip fracture were included in this analysis. Eleven thousand two hundred and fifteen (11,215) participants were on warfarin therapy prior to fracture and surgery, whereas 3804 participants were on NOACs. Results of this analysis showed that the risks of post-operative mortality (RR, 1.03; 95% CI, 0.92-1.16; P = 0.57), deep vein thrombosis (RR, 1.10; 95% CI, 0.41-2.98; P = 0.84), pulmonary embolism (RR, 1.17; 95% CI, 0.44-3.10; P = 0.75), stroke (RR, 1.25; 95% CI, 0.23-6.71; P = 0.80) and myocardial infarction (RR, 0.42; 95% CI, 0.03-6.98; P = 0.55) were not significantly different in patients who underwent surgery for hip fracture and who were on warfarin versus on NOACs. The risks of infection (RR, 0.90; 95% CI, 0.28-2.93; P = 0.87) and blood transfusion (RR, 1.08; 95% CI, 0.80-1.45; P = 0.62) were also similarly manifested. However, the length of hospital stay [WMD, - 0.93; 95% CI, - 1.83 to 0.03; P = 0.04] was significantly less in patients who were on NOACs in comparison to those who were on warfarin. CONCLUSIONS: The post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on NOACs were similar. However, those patients who were on warfarin had a significantly longer length of hospital stay.