Delayed surgery does not reduce transfusion rates in low energy hip fractures on direct oral anticoagulants (DOACs).

Overview

abstract

OBJECTIVES: To compare transfusion rates in patients on direct oral anticoagulants (DOACs) with non-anticoagulated patients undergoing hip fracture surgery and, secondarily, to determine if time to surgery or complications differ between these groups. DESIGN: Multicenter retrospective cohort. SETTING: Three tertiary care, academic, level I trauma centers Patients: Acute, operatively treated, low-energy hip fracture patients aged 55 and older were included. Anticoagulated patients were matched in a 1:2 ratio to "control" non-anticoagulated hip fracture patients using propensity score matching. MAIN OUTCOME MEASUREMENTS: The primary outcome was incidence of perioperative transfusion. Secondary outcomes include time to surgery, length of stay, 90-day complications, re-admissions, re-operations and mortality. RESULTS: 132 hip fracture patients admitted on DOACs were identified (107 factor Xa inhibitors, 25 dabigatran) and were matched to 262 "control" non-anticoagulated patients. There was no difference in overall transfusion rates between anticoagulation groups (43.2%; n=57 DOAC vs. 39.7%; n=104 control; p=0.517). Median time from admission to surgery was 41.7 hours in the DOAC group and 26.0 hours in the control group (p<0.001). There were no differences in 90-day complication, readmission, re-operation or mortality rates between DOAC and control groups. Comparing DOAC patients undergoing surgery within 24 hours and after 24 hours, there were no differences in transfusion rates (p=0.558) or overall complication rates (p=0.179). CONCLUSION: This study supports growing evidence that DOAC use should not be a determining factor in delaying surgery for hip fracture patients who are otherwise medically optimized. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.