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. 2022 Mar 4;58(3):379.
doi: 10.3390/medicina58030379.

Effect of Direct Oral Anticoagulants on Treatment of Geriatric Hip Fracture Patients: An Analysis of 15,099 Patients of the AltersTraumaRegister DGU®

Rene Aigner  1 , Benjamin Buecking  2 , Juliana Hack  1 , Ruth Schwenzfeur  3 , Daphne Eschbach  1 , Jakob Einheuser  1 , Carsten Schoeneberg  4 , Bastian Pass  4 , Steffen Ruchholtz  1 , Tom Knauf  1 , On Behalf Of The Registry For Geriatric Trauma Atr-Dgu  3
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Effect of Direct Oral Anticoagulants on Treatment of Geriatric Hip Fracture Patients: An Analysis of 15,099 Patients of the AltersTraumaRegister DGU®

Rene Aigner et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The increased use of direct oral anticoagulants (DOACs) results in an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC treatment on perioperative management of hip fracture patients is limited. In this study, we describe the prevalence of DOAC treatment in a population of hip fracture patients and compare these patients with patients taking vitamin K antagonists (VKA) and patients not taking anticoagulants. Materials and Methods: This study is a retrospective analysis from the Registry for Geriatric Trauma (ATR-DGU). The data were collected prospectively from patients with proximal femur fractures treated between January 2016 and December 2018. Among other factors, anticoagulation was surveyed. The primary outcome parameter was time-to-surgery. Further parameters were: type of anesthesia, surgical complications, soft tissue complications, length of stay and mortality. Results: In total, 11% (n = 1595) of patients took DOACs at the time of fracture, whereas 9.2% (n = 1325) were on VKA therapy. During the study period, there was a shift from VKA to DOACs. The time-to-surgery of patients on DOACs and of patients on VKA was longer compared to patients who did not take any anticoagulation. No significant differences with regard to complications, type of anesthesia and mortality were found between patients on DOACs compared to VKA treatment. Conclusion: An increased time-to-surgery in patients taking DOACs and taking VKA compared to non-anticoagulated patients was found. This underlines the need for standardized multi-disciplinary orthopedic, hematologic and ortho-geriatric algorithms for the management of hip fracture patients under DOAC treatment. In addition, no significant differences regarding complications and mortality were found between DOAC and VKA users. This demonstrates that even in the absence of widely available antidotes, the safe management of geriatric patients under DOACs with proximal femur fractures is possible.

Keywords: complications; direct oral anticoagulants; geriatric patient; hip fracture; time-to-surgery.

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Conflict of interest statement

The corresponding author declares, on behalf of all the authors, that there are no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of the prevalence of Vitamin K Antagonist and DOAC treatment at admission over the study period 2016–2018 (percentage of all anticoagulated patients).
Figure 2
Figure 2
Kaplan–Meier curves of time-to-surgery for therapeutic anticoagulation treatment. VKA: Vitamin K Antagonist; DOAC: direct oral anticoagulants.
See this image and copyright information in PMC

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