The influence of pre-operative antiplatelet and anticoagulant agents on the outcomes in elderly patients undergoing early surgery for hip fracture

Ueoka, Ken; Sawaguchi, Takahiro; Goshima, Kenichi; Shigemoto, Kazuhiro; Iwai, Shintaro; Nakanishi, Akira

doi:10.1016/j.jos.2018.12.027

Cited by 8 publications

(12 citation statements)

References 15 publications

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“…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.…”

Section: Discussionmentioning

confidence: 92%

“…The existing literature compares hip fracture groups with matched cohorts not taking anticoagulants [7][8][9][11][12][13][14] or groups' DOACs with other antithrombotics without separate analysis [6,10]. The most common management question asked by clinicians is ''what is the safest window to operate?".…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

Tarrant

Catanach

Sarrami

et al. 2020

JCM

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Timely surgical intervention in hip fracture has been linked to improved outcomes. Direct Oral Anticoagulants (DOACs) are an emerging class of anticoagulants without evidence-based guidelines on surgical timing. This study aims to investigate how DOACs affect surgical timing and hence perioperative outcomes. A retrospective database/registry review was conducted for geriatric hip fracture patients aged 65 and over between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included serious adverse events (SAE), transfusion and postoperative day (POD) 1 haemoglobin (Hb) levels. From a cohort of 3264 patients, 112 admitted subjects were taking DOACs; the annual proportion on DOACs increased over time. Mean time to surgery from last dose (Ts) was 2.2 (±1.0 SD) days. The primary outcome, 30-day mortality, occurred in 16 (14%) patients with secondary outcomes of SAEs in 25 (22%) patients and transfusion in 30 (27%) patients. Ts (days) did not significantly affect 30-day mortality (odds ratio (OR): 1.37, 95% confidence interval (CI): 0.80–2.33; p = 0.248), SAE (hazard ratio (HR): 1.03, 95% CI: 0.70–1.52; p = 0.885), transfusion (OR: 0.72 95% CI: 0.45 to 1.16; p = 0.177) or POD 1 Hb (OR: 1.99, 95% CI: −0.59 to 4.57; p = 0.129). Timing of surgery does not influence common surgical outcomes such as 30-day mortality, SAE, transfusion, and POD1 Hb in patients taking DOACs on admission.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

Tarrant

Catanach

Sarrami

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…On admission, cooperating with medical staffs, geriatricians at an orthopedic ward should comprehensively check physical examination, laboratory test, radioactive images, cardiovascular test, cognitive impairment, swallowing ability and fall risk-induced drugs [9][10][11]. Regarding polypharmacy (multieffectdrugs medication), geriatricians must avoid and reduce useless drugs while patients are in hospitalization.…”

mentioning

confidence: 99%