Key result
Patients anticoagulated with DOACs experienced a significant delay to hip fracture surgery (mean difference 14.52 hours) compared to controls, without an increased risk of 12-month mortality.
Why the study?
The study was conducted to determine if the use of DOAC in elderly patients with hip fractures leads to delays to theatre and/or an increased mortality risk.
Does DOAC use delay time to surgery or increase mortality in elderly patients requiring operative management of a hip fracture?
Meta-Analysis
Does DOAC use delay time to surgery or increase mortality in elderly patients requiring operative management of a hip fracture?
Mean Difference: 14.52 (95% CI 4.27–24.76)
In elderly patients with hip fractures, prior DOAC use is associated with a significant delay to surgery but does not increase 1-month or 12-month mortality or peri-operative transfusion requirements.
DOAC-related hip fracture surgery delay appears mortality-neutral; leaves open whether reversal protocols safely shorten wait times.
Hip fractures are a common presentation in the elderly, a group who commonly have co-morbidities requiring the use of anticoagulants. Recently, direct oral anti-coagulants (DOAC) have become a popular method of anticoagulating patients. The primary aim of this review is to determine if the use of DOAC in elderly patients with hip fractures results in delays to theatre and/or an increased mortality risk. Major databases including Pubmed, MEDLINE and Embase were searched for relevant studies and the included studies reference lists were screened for further studies. A total of 6 studies were included in meta-analysis which was undertaken using RevMan software with 95% confidence interval (CI). Compared to control groups, patients who were anticoagulated with DOAC and required operative management of a hip fracture experienced a statistically significant delay to treatment. However independent analysis showed these patients did not experience an increased mortality risk when compared to the control group. While data is limited, treating clinicians should be comforted by these findings as operative manage- ment can be safely delayed to reduce the risk of intraoperative bleeding.
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Holmes et al. (2021) conducted a meta-analysis in Hip fracture. Direct oral anti-coagulants (DOAC) vs. Non-anticoagulated controls was evaluated on Time to surgery (admission to operation interval) (MD 14.52, 95% CI 4.27-24.76). Patients anticoagulated with DOACs experienced a significant delay to hip fracture surgery (mean difference 14.52 hours) compared to controls, without an increased risk of 12-month mortality.
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