Key result
Early surgery (<48 hours) in hip fracture patients taking DOACs was associated with 0% 90-day mortality compared to 36% in those receiving delayed surgery (>48 hours) (P = .04).
Why the study?
Evidence-based guidelines regarding delay to theatre for urgent surgical intervention in patients taking DOACs are currently lacking.
Does early surgical fixation (<48 hours) improve outcomes and safety compared to delayed surgery in hip fracture patients taking DOACs?
Cohort (n=84)
No
Does early surgical fixation (<48 hours) improve outcomes and safety compared to delayed surgery in hip fracture patients taking DOACs?
Absolute Event Rate: 0% vs 36%
p-value: p=.04
Early surgical fixation (<48 hours) for hip fractures in patients taking DOACs appears safe and is associated with lower 90-day mortality compared to delayed surgery, suggesting DOAC use should not routinely delay operative management.
May support early DOAC resumption after hip fracture fixation without excess bleeding; leaves open need for randomized confirmation.
Introduction: Currently, evidence-based guidelines regarding delay to theatre for urgent surgical intervention in patients taking direct oral anticoagulants (DOACs) are lacking. Therefore, this study aims to investigate the effect of DOACs on patient outcomes receiving early (<48 hours) versus delayed (>48 hours) surgery for neck of femur fractures. Methods: A retrospective cohort study was conducted at a tertiary teaching hospital. Treatment groups were hip fracture patients taking DOACs on admission and receiving surgery in <48 hours (n = 17) and >48 hours (n = 11). A control cohort of hip fracture patients not taking DOACs (n = 56) was matched to the <48 hours treatment group for comparison. Patient demographics were recorded and key outcome measures included perioperative hemoglobin levels, transfusion rates, time to surgery, 90-day mortality, hematoma rates, and length of stay in hospital. Results: There was no significant difference in perioperative hemoglobin levels, transfusion rates, or hematoma between groups. Patients taking DOACs and receiving early surgery had significantly longer time to surgery compared to the non-DOAC control (32.21 ± 7.83 vs 25.98 ± 11.4, P = .01). No deaths were recorded in the early DOAC group at 90 days, compared to 4 (36%) in the late DOAC group ( P = .04). Discussion and Conclusions: Our study suggests hip fracture patients taking DOACs on admission is not a reason to delay surgery. However, given the lack of literature in this area, further prospective research with larger patient numbers is required to definitively guide clinical practice.
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King et al. (2020) conducted a cohort in Hip fractures (n=84). Early surgery (<48 hours) vs. Delayed surgery (>48 hours) was evaluated on 90-day mortality (p=.04). Early surgery (<48 hours) in hip fracture patients taking DOACs was associated with 0% 90-day mortality compared to 36% in those receiving delayed surgery (>48 hours) (P = .04).
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