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. 2025 Aug 19.
doi: 10.1007/s00198-025-07659-y. Online ahead of print.

The impact of direct oral anticoagulants on hip fracture care in Australia and New Zealand: a prospective patient sprint audit

Shalini Wijekulasuriya  1 , Hannah Seymour  2 , Seth Tarrant  3   4 , Zsolt J Balogh  3   4 , Pierre Navarre  5   6 , Jamie Hallen  7 , Sarah Hurring  8 , Rebecca Mitchell  9
Affiliations

The impact of direct oral anticoagulants on hip fracture care in Australia and New Zealand: a prospective patient sprint audit

Shalini Wijekulasuriya et al. Osteoporos Int. .

Abstract

Management of hip fracture patients on direct oral anticoagulants in Australia and New Zealand is unclear. Hip fracture patients on DOACs had three times higher odds of time to surgery > 36 h than patients on no antithrombotic medication. Balancing individual considerations and guidelines may shorten time to surgery.

Purpose: The management of hip fracture patients taking direct oral anticoagulants (DOACs) requires balancing anticoagulation concerns and adherence to recommendations of surgery within 36 h. This study compares the management and time to surgery of hip fracture patients in Australia and New Zealand who were on DOACs, other antithrombotic medication, and no antithrombotic medication.

Method: A sprint audit of hospitals participating in the Australian and New Zealand Hip Fracture Registry (ANZHFR) was conducted. Sprint audit data regarding DOAC use, demographics, and clinical management was collected for consecutive patients aged ≥ 50 years admitted to hospital with a hip fracture between 1 June and 30 July 2024. The primary outcome was time to surgery.

Results: Of 1043 hip fracture patients, 192 (18%) were taking DOACs on presentation to hospital. Patients on DOACs had 3 times higher odds (OR 3.65, 95% CI 2.40-5.55), and patients on other antithrombotic medication had 1.6 times higher odds (OR 1.62, 95% CI 1.12-2.34) of time to surgery > 36 h, compared to patients on no antithrombotic medication. The median time to surgery for patients on DOACs was 39 h (IQR 24-48); for patients on no or other antithrombotic medication, time to surgery was 25 h (IQR 20-39) and 27 h (IQR 20-44), respectively. There were no differences in the proportion of patients who had perioperative blood transfusions.

Conclusions: Patients on DOACs are likely to experience delays to surgery compared to patients on no antithrombotic medication, beyond what patients on other antithrombotic medications may experience.

Keywords: Audit; Direct oral anticoagulant; Hip fracture; Registry.

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Conflict of interest statement

Declarations. Ethics: The DOAC sprint audit and the ANZHFR have ethical approval from a lead Human Research Ethics Committee in each Australian jurisdiction and in New Zealand and local governance approvals from each participating hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the jurisdictional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Conflicts of interest: None.

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