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Introduction Surgical intervention within 48 hours of admission in patients with acute hip fractures has been associated to lower morbidity and mortality. Patients anticoagulated with Vitamin K Antagonists (VKAs) have longer time to corrective surgery than those not anticoagulated. Sparse data exists on time to surgery (TTS) in patients taking direct oral anticoagulants (DOACs). The aim of this study is to establish TTS among non-anticoagulated and anticoagulated patients taking either VKA or DOAC. Materials and Methods We conducted a retrospective cohort study of consecutive patients admitted with acute hip fracture between July 1, 2016 and December 31, 2017. Patient-, anticoagulant- and surgery-related characteristics were collected. The primary outcome was TTS calculated from time of admission. Median TTS with interquartile range (IQR) was compared among 3 groups of patients: DOAC, VKA and No OAC. Results A total of 472 patients were included: 12.5% (59/472) were anticoagulated (28/472 on VKAs and 31/472 on DOACs). Median TTS was longer in the VKA group [64 hours (IQR: 50-84)] and in the DOAC group [(61 hours; IQR: 42 to 77)] versus the No OAC group [44 hours (IQR: 28-63), p =0.0006 and p=0.003 respectively]. There was no significant difference in median TTS in the VKA group versus the DOAC group (p =0.6396). Conclusion Patients taking either VKA or DOAC have significant delays to emergency hip fracture surgery compared to those not anticoagulated. An action plan aimed at early identification and cessation of anticoagulation is warranted in this vulnerable group of patients. Keywords: Direct Oral anticoagulants, Vitamin K antagonists, Anticoagulation, Acute hip fracture, Emergency surgery Disclosures Tagalakis: BMS-Pfizer: Other: participated on ad boards; Sanofi Aventis: Other: investigator initiated grant;participated on ad boards; Pfizer: Other: participated on ad boards; Bayer: Other: participated on ad boards; Servier: Other: participated on ad boards.

Corrigendum to "Delayed time to emergency hip surgery in patients taking oral anticoagulants" [Thromb Res. 184 (2019 Dec) 110-114] ☆

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Objectives: To determine the time to surgery (TTS) among patients with acute hip fracture who are anticoagulated with vitamin K antagonists (VKAs) who receive prothrombic complex concentrate (PCC) compared to those who do not receive PCC.Method: We conducted a retrospective cohort study of consecutive patients with an acute hip fracture presenting to the emergency department (ED) of the Jewish General Hospital, a 637-bed tertiary care hospital center in Montreal, Quebec, between January 1st, 2015 and March 1st, 2020. Eligible patients were identified via the ED electronic database. Inclusion criteria were: (1) > 18 years of age; (2) acute hip fracture and admission for surgical repair; (3) VKA use and international normalized ratio (INR) > 1.5 at admission. Follow-up was limited to index hospitalization. The primary outcome of TTS, reported in hours, was defined as the time from hospital admission to the time of surgery. Mann-Whitney U test was used to assess any difference in median TTS between the two groups. Results: A total of 53 patients were included in our cohort of which 43.4% (23/53) received PCC with a median time to first dose of 25.5 hours (IQR 19.4-51.6). 84.9 % (45/53) received vitamin K with a median time to the first dose of 16 h (IQR 7.5-26.7). The median TTS in the PCC and no PCC groups was 51.8 h (IQR 26.8–71.4) vs. 63.5 h (IQR 49.4-73.2) respectively (p=0.71). Conclusion: This study did not identify shorter TTS between patients who received PCC and those who did not. Median TTS in both groups surpassed the recommended 48h benchmark, and PCC and vitamin K administration timing was suboptimal. These findings demonstrate a significant care gap among this vulnerable population and represent a call for future initiatives to ensure a more streamlined and multidisciplinary approach to anticoagulation management starting at the onset of presentation criteria were: (1) > 18 years of age; (2) acute hip fracture and admission for surgical repair; (3) VKA use and international normalized ratio (INR) ˃ 1.5 at admission. Follow-up was limited to index hospitalization. The primary outcome of TTS, reported in hours, was defined as time from hospital admission to time of surgery. Mann-Whitney U test was used to assess any difference in median TTS between the two groups. RésuméObjectifs: Déterminer le délai avant l’intervention chirurgicale (DAIC) parmi les patients présentant une fracture aigüe de la hanche qui suivent une anticoagulothérapie par des antagonistes de la vitamine K (AVK) et qui reçoivent un concentré de complexe prothrombique (CCP) par rapport à ceux qui ne reçoivent pas le CCP. Méthodologie: Nous avons mené une étude de cohorte rétrospective de patients consécutifs présentant une fracture aigüe de la hanche à leur arrivée à l’urgence de l’Hôpital général juif, un centre hospitalier de 637 lits de soins tertiaires situé à Montréal (Québec), entre le 1er janvier 2015 et le 1er mars 2020. Les patients admissibles ont été repérés par l’intermédiaire de la base de données électronique du service des urgences. Les critères d’inclusion sont : 1) personne âgée de plus de 18 ans; 2) fracture aiguë de la hanche et hospitalisation en vue d’une réparation chirurgicale; 3) prise d’AVK et rapport international normalisé (RIN) supérieur à 1,5 lors de l’admission à l’hôpital. Le suivi se limite à l’admission initiale. Le critère d’évaluation principal du DAIC, indiqué en heures, est défini comme étant le délai entre l’admission à l’hôpital et le moment de l’intervention chirurgicale. Le test U de Mann-Whitney est utilisé pour évaluer toute différence dans les DAIC médians entre les deux groupes. Résultats: Au total, 53 patients font partie de la cohorte dont 43,4 % (23/53) ont reçu le CCP, le délai médian avant la première dose étant de 25,5 heures (écart interquartile [EI] de 19,4 à 51,6), et 84,9 % (45/53) ont reçu de la vitamine K, le délai médian avant la première dose étant de 16 heures (EI de 7,5 à 26,7). Le DAIC médian est de 51,8 heures (EI de 26,8 à 71,4) pour le groupe recevant le CCP et de 63,5 heures (EI de 49,4 à 73,2) pour celui ne recevant pas le CCP (p = 0,71). Conclusion: Cette étude révèle une tendance vers des DAIC plus courts chez les patients recevant le CCP que chez ceux qui ne le reçoivent pas. Le DAIC médian dans les deux groupes est supérieur au délai de référence recommandé de 48  heures, et le moment où le CCP et la vitamine  K sont administrés est sous-optimal. Ces constatations montrent une lacune importante en matière de soins chez cette population vulnérable et représentent un appel à des initiatives visant à assurer une approche simplifiée et multidisciplinaire de la prise en charge de l’anticoagulothérapie qui commence dès l’arrivée du patient à l’hôpital.