Key result
Ongoing treatment with direct oral anticoagulants at the time of hip fracture significantly delayed time to surgery compared to matched controls (3.6 vs 2.15 days, p<0.0001).
Why the study?
The study investigated the effects of ongoing DOAC treatment on time to surgery and in-hospital outcomes in hip fracture patients, and evaluated adherence to current guidelines regarding timing of surgery after the last dose.
Does ongoing treatment with DOACs delay time to surgery and worsen in-hospital clinical outcomes in patients with hip fracture?
Observational (n=280)
No
Does ongoing treatment with DOACs delay time to surgery and worsen in-hospital clinical outcomes in patients with hip fracture?
Absolute Event Rate: 3.6% vs 2.15%
p-value: p=<0.0001
In elderly patients with hip fracture, ongoing DOAC treatment significantly delays time to surgery and increases the risk of severe postoperative anemia, though it does not appear to increase in-hospital mortality.
DOAC use at hip fracture was associated with delayed surgery; leaves open effects on outcomes and reversal protocols.
Aim of the present study was to investigate the effects of ongoing treatment with DOACs on time from trauma to surgery and on in-hospital clinical outcomes (blood losses, need for transfusion, mortality) in patients with hip fracture. Moreover we evaluated the adherence to current guidelines regarding the time from last drug intake and surgery. In this observational retrospective study clinical records of patients admitted for hip fracture from January 2016 to January 2019 were reviewed. 74 patients were in treatment with DOACs at hospital admission. Demographic data, comorbidities and functional status before trauma were retrieved. As control group we evaluated 206 patients not on anticoagulants matched for age, gender, type of fracture and ASA score. Time to surgery was significantly longer in patients treated with DOACs (3.6 + 2.7 vs. 2.15 ± 1.07 days, p < 0.0001) and treatment within 48 h was 47% vs. 80% in control group (p < 0.0001). The adherence to guidelines' suggested time from last drug intake to surgery was 46%. Neither anticipation nor delay in surgery did result in increased mortality, length of stay or complication rates with the exception of larger perioperative blood loss (Hb levels < 8 g/dl) in DOACs patients (34% vs 9% p < 0.0001). Present results suggest that time to surgery is significantly longer in DOAC patients in comparison to controls and adherence to guidelines still limited.
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Rostagno et al. (2021) conducted an observational in Hip fracture (n=280). Direct oral anticoagulants (DOACs) vs. Patients not on anticoagulants was evaluated on Time to surgery (days) (p=<0.0001). Ongoing treatment with direct oral anticoagulants at the time of hip fracture significantly delayed time to surgery compared to matched controls (3.6 vs 2.15 days, p<0.0001).
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