Key result
DOAC use prior to hip fracture did not significantly increase surgical delay compared to no anticoagulation (28.9 vs 26.1 hours, p=0.26).
Why the study?
The perioperative consequences of DOACs in hip fracture patients have not been sufficiently investigated, including whether DOAC users experience delayed surgery.
Does DOAC use prior to fracture increase surgical delay or perioperative complications in hip fracture patients aged ≥ 60?
Observational (n=314)
No
Does DOAC use prior to fracture increase surgical delay or perioperative complications in hip fracture patients aged ≥ 60?
Absolute Event Rate: 28.9% vs 26.1%
p-value: p=0.26
DOAC use prior to hip fracture surgery does not significantly increase surgical delay, length of hospital stay, or major bleeding complications, suggesting early surgical intervention is safe.
Supports early hip fracture surgery in DOAC users; leaves open need for randomized confirmation of safety.
PURPOSE: The perioperative consequences of direct oral anticoagulants (DOACs) in hip fracture patients are not sufficiently investigated. The primary aim of this study was to determine whether DOAC-users have delayed surgery compared to non-users. Secondarily, we studied whether length of hospital stay, mortality, reoperations and bleeding complications were influenced by the use of DOAC. METHODS: The medical records of 314 patients operated for a hip fracture between 2016 and 2017 in a single trauma center were assessed. Patients aged < 60 and patients using other forms of anticoagulation than DOACs were excluded. Patients were followed from admission to 6 months postoperatively. Surgical delay was defined as time from admission to surgery. Secondary outcomes included length of hospital stay, transfusion rates, perioperative bleeding loss, postoperative wound ooze, mortality and risk of reoperation. The use of general versus neuraxial anaesthesia was registered. Continuous outcomes were analysed using Students t test, while categorical outcomes were expressed by Odds ratios. RESULTS: 47 hip fracture patients (15%) were using DOACs. No difference in surgical delay (29 vs 26 h, p = 0.26) or length of hospital stay (6.6 vs 6.1 days, p = 0.34) were found between DOAC-users and non-users. DOAC-users operated with neuraxial anaesthesia had longer surgical delay compared to DOAC-users operated with general anaesthesia (35 h vs 22 h, p < 0.001). Perioperative blood loss, transfusion rate, risk of bleeding complications and mortality were similar between groups. CONCLUSION: Hip fracture patients using DOAC did not have increased surgical delay, length of stay or risk of reported bleeding complications than patients without anticoagulation prior to surgery. The increased surgical delay found for DOAC-users operated with neuraxial anaesthesia should be interpreted with caution.
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Leer-Salvesen et al. (2020) conducted an observational in Hip fracture (n=314). Direct oral anticoagulants (DOACs) vs. No anticoagulation was evaluated on Surgical delay (time from admission to surgery in hours) (p=0.26). DOAC use prior to hip fracture did not significantly increase surgical delay compared to no anticoagulation (28.9 vs 26.1 hours, p=0.26).
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