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Treatment and outcome after hip fracture for patients on oral anticoagulation

Alexander Wilton1, Ayman Sorial1, Tanzeelah Jamadar1

  • 1North West Anglia Foundation Trust, Peterborough, United Kingdom.

Injury
|December 6, 2024
PubMed

Insights

Hip fracture patients on anticoagulation, including direct oral anticoagulants (DOAC), can safely undergo surgery. Current management policies ensure no increased risk of complications or mortality, despite slight delays in theatre timing.

Area of Science:

  • Orthopedic Surgery
  • Geriatric Medicine
  • Pharmacology

Background:

  • Increasing prevalence of hip fracture patients on oral anticoagulation, including DOAC.
  • Uncertainty regarding optimal surgical timing and complication rates in these patients.

Purpose of the Study:

  • To compare treatment and outcomes for hip fracture patients taking anticoagulation versus those not on anticoagulation.
  • To evaluate the safety of current surgical timing policies for hip fracture patients on anticoagulation.

Main Methods:

  • Retrospective analysis of 3,707 hip fracture patients over seven years.
  • Comparison of patient demographics, comorbidities, and perioperative outcomes based on anticoagulation status (warfarin, DOAC, none).

Main Results:

  • Significant increase in DOAC use (1.4% to 11.4%) and slight decrease in warfarin use (6.1% to 4.7%) over the study period.
  • Patients on anticoagulation were older and more likely to have atrial fibrillation.
  • Increased delay to theatre (37.9-39.5 hours) for anticoagulated patients compared to non-anticoagulated patients (31.1 hours).
  • No significant differences observed in transfusion rates, wound complications, post-operative hemoglobin, or 30-day mortality.

Conclusions:

  • Current management policies for hip fracture surgery in patients on oral anticoagulation are safe.
  • Perioperative outcomes, including mortality and complications, are not adversely affected by anticoagulation status.
Abstract

Keywords:
AnticoagulationComplicationsHip fractureOrthogeriatricsTiming of surgery

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