Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis

Abstract

Introduction The management of patients with a hip fracture is affected by the use of oral anticoagulants. A cross-sectional analysis was undertaken to investigate health outcome differences in those anticoagulated compared to those not anticoagulated. Methods Patients aged 50 years and over presenting to a large university hospital with hip fractures were identified from the service registry. Patient characteristics and health outcomes between those not anticoagulated were compared with those anticoagulated (warfarin and direct oral anticoagulants, DOAC). Results 200/2307 (9%) patients were anticoagulated. 84% were on warfarin, and the rest a DOAC. Compared to those anticoagulated, there was a higher prevalence of dementia (25% vs. 18%, p = 0.02) and a lower prevalence of cardiovascular disease (54% vs. 78%, p < 0.01), atrial fibrillation (10% vs. 82%, p < 0.01), and polypharmacy (55% vs. 76%, p < 0.01). Renal function was lower in the anticoagulated group. Time to operation for those not anticoagulated and anticoagulated was a median (IQR) of 25 (15) and 27 (18) hours. There was no difference in blood transfusion and hospital mortality. Postoperative complications were similar except a higher rate of renal failure (14% vs. 19%, p = 0.04) and heart failure (1% vs. 5%, p < 0.01), and a longer length of stay [median (IQR): 14 (10) vs. 16 (12) days] in the anticoagulated group. This was no longer significant after adjustment of confounders. Conclusion There was no statistically significant difference in health outcomes between those anticoagulated and those not after adjusting for patient characteristics. It was feasible to avoid significant delay in hip fracture surgery in those anticoagulated.

Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

“…The study has larger numbers than the existing literature (n = 7 [6], n = 19 [7], n = 27 [8], n = 28 [9], n = 29 [10], n = 33 [16], n = 47 [11], n = 52 [15], n = 54 [12], n = 63 [13] and n = 89 [14]). It also specifically focuses on assessing a dose-response relationship within a cohort taking DOACs; this approach avoids the potential bias of finding a suitable non-DOAC control group and should be considered for future studies.…”

“…National pharmaceutical subsidies have resulted in a steady increase in usage [5]. The existing literature examining DOAC use in hip fracture is small [6][7][8][9][10][11][12][13][14][15][16], and often focuses on comparing DOAC cohorts with groups not taking them, which results in differences between group comorbidity profiles. The appropriate perioperative management for DOACs in hip fracture has been recently queried [17], with expert opinion suggesting a waiting period of 24-48 hours, based on DOAC half-lives and guidelines for elective surgery [18].…”

Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A systematic review and meta-analysis

“…Hoerlyck et al [23] The study compared non-antiplatelet medication. remaining studies (p = 0.45; I 2 = 0%), and it did not change the overall results when this outlier study was removed.…”

Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A Systematic Review and Meta-analysis

“…Lee et al 2012 [47] The study compared non-antiplatelet medication Drescher et al 2014 [48] The study compared non-antiplatelet medication Kulachote et al 2015 [49] The intervention group was with non-antiplatelet drugs concurrently Akaoka et al 2016 [50] The intervention group was with non-antiplatelet drugs concurrently Purushothaman et al 2016 [51] These groups were divided into early surgery group or delayed surgery group based on the time from admission to theatre less than or more than 48 hours. Hwang et al 2016 [52] The intervention group was with non-antiplatelet drugs concurrently Zhang et al 2017 [53] Antiplatelet intervention group was with delayed surgery for more than 5 days Lott et al 2018 [54] The intervention group was with non-antiplatelet drugs concurrently Hoerlyck et al 2019 [55] The study compared non-antiplatelet medication…”