Older patients on anticoagulants may benefit from early vs. delayed hip fracture surgery
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Key takeaways:
- Patients with hip fractures surgically treated early after their last direct oral anticoagulant dose had shorter length of stay vs. those treated late.
- Patients treated early also required fewer transfusions.
SEATTLE — Results presented here showed older patients who are taking direct oral anticoagulants may experience worse clinical outcomes after delayed hip fracture surgery vs. those who are treated early.
“We found that among hip fracture patients on [direct oral anticoagulants] DOACs, those treated early are less likely to require transfusion and are able to leave sooner and get home,” Devon T. Brameier, MD, said in her presentation at the Orthopaedic Trauma Association Annual Meeting. “So, while these patients are overall at a higher risk of bleeding compared to the general population, early treatment of geriatric patients with hip fractures who are on DOACs does not increase their bleeding, complications or mortality risks, and actually shortens their length of stay with fewer transfusions required.”
Brameier and colleagues retrospectively reviewed data from 205 patients aged at least 65 years with hip fractures and who were prescribed DOACs prior to hip surgery at three level-1 trauma centers between 2010 and 2018. Researchers categorized patients into two groups based on whether they underwent surgery less than 48 hours after their last DOAC dose (n = 71) or more than 48 hours after their last DOAC dose (n = 134). Outcomes measured included length of stay, transfusion rate, complication rate, readmission rate and 1-year mortality rate.
Researchers found patients treated less than 48 hours after their last DOAC dose had a significantly shorter length of stay (5.9 days vs. 7.6 days) compared with patients treated more than 48 hours after their last dose. In addition, Brameier said patients treated less than 48 hours after their last DOAC dose also required fewer transfusions than patients treated more than 48 hours after their last dose.
Researchers found no significant differences in complication rates (wound complications, infections and venous thromboembolic events), readmission rates or 1-year mortality rates between the two groups.
“There is additional need for coordination and discussion in a multidisciplinary team regarding medical clearance in the event of a patient who presents with a hip fracture and is on a DOAC,” Brameier said. “Given the known increase in mortality associated with the delay to surgery for hip fractures, surgeons should be considering and pushing for early intervention in this subpopulation rather than adhering to guidelines that have been set for elective procedures.”
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Brameier DT, et al. Paper 71. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 18-21, 2023; Seattle.
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