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Meta-Analysis
. 2025 Aug;36(8):1347-1357.
doi: 10.1007/s00198-025-07572-4. Epub 2025 Aug 7.

Effects of pre-operative continuing oral anticoagulants or antiplatelets on health outcomes among older patients with hip fracture: a systematic review and meta-analysis

Ning Tang  1 , Jing Zhang  1 , Xinyan Liu  1 , Dongchen Yao  2 , Xinyi Zhang  1   3 , Pengpeng Ye  4 , Tingzhuo Liu  1 , Jinyu Liang  1 , Wang Yang  5 , Elizabeth Armstrong  6 , Paul Mitchell  7   8   9 , Rebecca Ivers  6 , Ronald Man Yeung Wong  10 , Yongchen Wang  3 , Minghui Yang  11   12   13 , Maoyi Tian  14   15
Affiliations
Meta-Analysis

Effects of pre-operative continuing oral anticoagulants or antiplatelets on health outcomes among older patients with hip fracture: a systematic review and meta-analysis

Ning Tang et al. Osteoporos Int. 2025 Aug.

Abstract

Continuing antiplatelets during hip fracture surgery may be safe for older adults, while early surgery after discontinuation reduces hospital stay without adverse outcomes.

Purpose: The safety of continuing antiplatelets or direct oral anticoagulants (DOACs) before surgery in older patients with hip fractures remains uncertain. The feasibility of timely surgery after discontinuation also warrants further investigation.

Methods: We included studies of hip fracture patients aged ≥ 65 years taking antiplatelets or DOACs, comparing continuation versus discontinuation, or early versus delayed surgery. MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched to November 2024. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were conducted using a random-effects model to pool effect estimates. This study was registered with PROSPERO (CRD42022378334).

Results: Thirteen observational studies from nine countries involving 885 patients were included. There were no significant differences in transfusion rates in patients who continued the medication (Odds Ratio [OR] = 0.87; 95% Confidence Interval [CI]: 0.37 to 2.03). Surgery within 48 h of antiplatelet discontinuation was associated with shorter hospital stay (mean difference = - 5.71 days; 95% CI: - 8.36 to - 3.06) compared to those with delayed surgery, with no increase in transfusion (OR = 0.75; 95% CI: 0.04 to 13.73) and in-hospital mortality (OR = 0.49; 95% CI: 0.02 to 13.52). For DOAC users, no significant differences were observed in transfusion (OR = 1.09; 95% CI: 0.56 to 2.09) and 30-day mortality (OR = 1.53; 95% CI: 0.45 to 5.19) for early versus delayed surgery.

Conclusions: Surgery without discontinuing antiplatelets may be safe. Early surgery after discontinuing antiplatelets could reduce hospital stays without adverse outcomes. Randomized trials are needed to confirm these findings.

Keywords: Antiplatelet therapy; Direct oral anticoagulants; Hip fracture; Older adults.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study did not involve primary data collection or direct interaction with patients. All data used were extracted from previously published studies that were publicly available. Ethical approval and patient consent were not required for this systematic review and meta-analysis. Consent for publication: Not required. Conflicts of interest: None.

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