Expedited surgery does not increase transfusion rates for patients with geriatric hip fracture taking factor Xa inhibitors

Abstract

Objectives: Geriatric patients who sustain hip fractures and are taking factor Xa inhibitors (Xa-I) experience surgical delay. Our institution developed a pharmacokinetic protocol to formally guide and expedite surgical timing for these patients. The protocol is based on the patient's renal function and timing of last Xa-I dose. For patients with impaired renal function, longer wait times are recommended. The purpose of this study was to determine the effects of this protocol for patients with geriatric hip fracture taking Xa-I. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients/Participants: A total of 164 patients aged 65 and older who were taking Xa-I before admission and underwent hip fracture surgery; 68 patients in the Standard group (2014–2018) and 96 patients in the Expedited group (2020–2022, after protocol implementation). Intervention: Hip fracture surgery. Main Outcome Measurements: Time to surgery (TTS), transfusion rate, blood loss, 90-day complication rates. Results: The median TTS was significantly shorter in the Expedited group (28.6 hours, interquartile range 21.3 hours) than in the Standard group (44.8 hours, interquartile range 21.1 hours) (P < .001). There were no differences in overall transfusion rates. Multivariable regression analysis demonstrated that time to surgery was not predictive of transfusion rate in all patients (OR 1.00, 95% CI 0.99–1.02, P = .652). There were no differences in blood loss or rates of 90-day complications. Conclusion: Geriatric patients with hip fractures and taking factor Xa inhibitors may warrant earlier surgery without an increased risk of transfusion or bleeding. Level of Evidence: Therapeutic Level III.