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Updated: Feb 4, 2026
Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Impact of Direct Oral Anticoagulants in Patients With Hip Fractures
Martin Bruckbauer1,2, Oliver Prexl1,2, Wolfgang Voelckel1
1Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Center Salzburg, Academic Teaching Hospital, Paracelsus Medical University, Salzburg, Austria.
Insights
Direct oral anticoagulants (DOACs) in hip fracture patients led to delayed surgery. However, DOACs did not increase bleeding risk compared to Coumadin (COU), suggesting earlier surgical fixation may be beneficial.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Pharmacology
Background:
- Hip fractures (HFs) are a significant health concern in elderly populations.
- Antithrombotic therapy is common in patients with HF, influencing surgical management.
- Direct oral anticoagulants (DOACs) and Coumadin (COU) are frequently used anticoagulants.
Purpose of the Study:
- To compare the impact of DOACs versus COU on outcomes in patients with hip fractures.
- To evaluate differences in surgical timing, blood loss, and other complications between anticoagulant groups.
Main Methods:
- Retrospective cohort analysis of 320 patients (≥65 years) with isolated hip fractures.
- Patients were categorized into three groups: no antithrombotic therapy (no-ATT), COU, and DOACs.
- Key outcomes included time to surgery, blood loss, mortality, and hospital length of stay.
Main Results:
- Patients on COU and DOACs had higher Charlson Comorbidity Index scores.
- Time to surgery was significantly longer for DOAC patients compared to the no-ATT group.
- No significant differences were observed in postoperative hemorrhage, ICU length of stay, or mortality between groups.
Conclusions:
- DOAC use in hip fracture patients is associated with a prolonged interval until surgical repair.
- No increased bleeding rates were identified for DOACs compared to COU in this cohort.
- Earlier surgical hip fixation may be warranted for patients on DOACs.
Objective:
To assess the impact of direct oral anticoagulant (DOAC) intake compared with Coumadin (COU) in patients suffering hip fractures (HFs).
Design:
Retrospective cohort analysis.
Setting:
Level 1 Trauma Center.
Intervention:
Timing of surgical hip fixation.
Patients:
Three-hundred twenty patients 65 years of age or older with isolated HF were enrolled into the study: 207 (64.7%) without any antithrombotic therapy (no-ATT), 59 (18.4%) on COU, and 54 (16.9%) on DOACs.
Main Outcome Measurements:
Time to surgery, blood loss, mortality, hospital length of stay, red blood cell transfusion, use of reversal agents, and Charlson Comorbidity Index.
Results:
Patients on COU and DOACs had a higher Charlson Comorbidity Index compared with the no-ATT group (P < 0.0001). Despite the fact that significantly more patients received reversal agents in the COU group compared with DOAC medication (P < 0.0001), percentage of transfused patients were similar (54.2% vs. 53.7%). Time to surgery was significantly shorter in the no-ATT group when compared with DOAC patients (12-29.5 hours, respectively). No difference in postoperative hemorrhage, intensive care unit length of stay, and mortality was observed between groups.
Conclusions:
DOAC medication in HF patients caused long elapse time until surgical repair. We found no evidence of higher bleeding rates in HF patients on DOACs compared with COUs. Earlier HF fixation might be indicated in DOAC patients.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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