Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar;52(3):418-425.
doi: 10.1111/imj.15007. Epub 2022 Jan 12.

Outcomes and anticoagulation use for elderly patients that present with an acute hip fracture: multi-centre, retrospective analysis

Katherine Creeper  1   2 , Andrew Stafford  3 , Sophie Reynolds  4 , Sapna Samida  4 , Stephanie P'Ng  2   5 , Denise Glennon  6 , Hannah Seymour  7 , Carolyn Grove  1   2   8
Affiliations

Outcomes and anticoagulation use for elderly patients that present with an acute hip fracture: multi-centre, retrospective analysis

Katherine Creeper et al. Intern Med J. 2022 Mar.

Abstract

Background: Hip fractures are a common problem and corrective surgery is recommended within 24 h. However, most peri-operative direct oral anticoagulant (DOAC) guidelines suggest a washout period of 48 h before major surgery. There are limited data on utility of drug levels.

Aim: To investigate the effect of DOAC therapy on time to surgery and patient outcomes, and to explore the impact of different pre-operative protocols on surgical delay.

Methods: A multi-centre, retrospective analysis of all adult patients that presented with acute hip fracture at three tertiary hospitals in Perth, Western Australia, was performed. Data were collated from the West Australian hip fracture registry and electronic records. Time to theatre, DOAC levels, bleeding and transfusion rates were compared between sites.

Results: Of 1240 hip fracture patients, 146 (11.9%) were on anticoagulation, with more patients taking a DOAC than warfarin. The time to surgery was significantly longer for those on a DOAC compared with those on warfarin (P = 0.003). There was no difference in bleeding, transfusion requirement or 30-day mortality in patients taking a DOAC compared to those on warfarin. Fifty-eight (70.7%) patients had a DOAC level prior to surgery. Of 25 patients who had a level performed within 12 h of presentation, 13 (52%) had a result of ≤50 ng/mL. Outcomes were similar between sites.

Conclusion: People on DOAC treatment had a significant delay before corrective surgery compared with those on warfarin. The frequent finding of early DOAC levels <50 ng/mL suggests this delay may be unnecessary in a significant proportion of patients.

Keywords: anticoagulation; elderly; fracture; hip; outcome.

PubMed Disclaimer

References

    1. Australian Institute of Health and Welfare. Hip Fracture Incidence and Hospitalisations in Australia. Canberra: Australian and New Zealand Hip Fracture Registry; 2018.
    1. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. Can Med J Assoc 2010; 182: 1609.
    1. Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004; 291: 1738.
    1. Sheehan KJ, Sobolev B, Villan Villan YF, Guy P. Patient and system factors of time to surgery after hip fracture: a scoping review. Br Med J Open 2017; 7: e016939.
    1. Australian and New Zealand guideline for hip fracture care. Improving Outcomes in Hip Fracture Management of Adults. Sydney: Australian and New Zealand Hip Fracture Registry Steering Group; 2014.