Early hip fracture surgery (within 48 hours) in patients on direct oral anticoagulants was associated with lower 30-day mortality compared to delayed surgery (1.2% vs 5.9%; risk difference -4.4%).
Cohort (n=3,429)
No
Does early surgery reduce 30-day mortality in patients receiving direct oral anticoagulants and admitted for hip fracture?
Early hip fracture surgery (within 48 hours) is associated with improved 30-day survival even in patients previously treated with direct oral anticoagulants.
Absolute Risk Reduction: 4.4
Absolute Event Rate: 1.2% vs 5.9%
Absolute Risk Reduction: 4.4%
BACKGROUND: Early hip fracture surgery is recommended to decrease mortality, however the impact of a delay in surgery due to previous treatment with direct oral anticoagulants (DOA) is unknown. Our objective was to determine if early surgery, defined as surgery within 48 h of hospital admission is associated with decreased postoperative mortality. We tested the hypothesis that early surgery was beneficial with regard for mortality in patients treated with direct oral anticoagulants. METHODS: Retrospective cohort study in a French University Hospital including patient admitted for Hip fracture. The main exposure was wait time for surgery defined as the total time, in hours, between hospital admission and surgery. The main outcome was mortality within 30 days after hip fracture surgery. RESULTS: In 3429 patients, the overall 30-day mortality was 4.1% (95% CI 3.5%; 4.9%). In DOA + patients, the 30-day mortality rates in the early and delayed surgery groups were 1.2% and 5.9%, respectively, with estimated risk difference of -4.4 (with a 2% probability of this difference is > 0). In the DOA + group, early surgery tended to be associated with a higher percentage receiving red-blood cells (64.6% vs 54.8%, respectively, estimated risk difference of 9.9% with a 93% probability of this difference is > 0) and lower risk of pneumonia (1.2% vs 8.2%, respectively; estimated difference of -6.7% with 0.3% probability of superiority). CONCLUSION: Early hip fracture surgery was associated with improved survival in patients previously treated with DOAs.
Noll et al. (Fri,) conducted a cohort in Hip fracture in patients receiving direct oral anticoagulants (n=3,429). Early surgery (within 48 h of hospital admission) vs. Delayed surgery was evaluated on mortality within 30 days after hip fracture surgery (risk difference -4.4). Early hip fracture surgery (within 48 hours) in patients on direct oral anticoagulants was associated with lower 30-day mortality compared to delayed surgery (1.2% vs 5.9%; risk difference -4.4%).