Delayed Surgery Does Not Reduce Transfusion Rates in Low-Energy Hip Fractures on Direct Oral Anticoagulants

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Pharmacology

Background:

• Hip fractures are common in elderly patients, often requiring surgery.
• Anticoagulation therapy is frequently used in this population for various indications.
• The management of anticoagulated patients undergoing hip fracture surgery presents clinical challenges regarding surgical timing and outcomes.

Purpose of the Study:

• To compare perioperative transfusion rates in hip fracture patients on direct oral anticoagulants (DOACs) versus nonanticoagulated patients.
• To assess differences in time to surgery and 90-day complications between these groups.

Main Methods:

• Multicenter retrospective cohort study involving three academic Level I trauma centers.
• Included patients aged 55 years and older with acute, operatively treated hip fractures.
• Propensity score matching was used to compare 132 DOAC patients with 262 nonanticoagulated controls.

Main Results:

• No significant difference in overall perioperative transfusion rates between DOAC and control groups (43.2% vs. 39.7%).
• DOAC patients experienced a longer median time to surgery (41.7 hours vs. 26.0 hours, P < 0.001).
• No significant differences in 90-day complications, readmissions, reoperations, or mortality were observed between groups.

Conclusions:

• DOAC use is not associated with increased transfusion rates in hip fracture surgery.
• Surgery for hip fracture patients on DOACs should not be delayed solely due to anticoagulation status if medically optimized.
• Findings support current evidence suggesting safe surgical management of hip fracture patients on DOACs.