Impact of Direct Oral Anticoagulants in Patients With Hip Fractures

Bruckbauer, Martin; Prexl, Oliver; Voelckel, Wolfgang G.; Ziegler, Bernhard; Grottke, Oliver; Maegele, Marc; Schöchl, Herbert

doi:10.1097/bot.0000000000001329

Cited by 50 publications

(56 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Drop in Hb has been demonstrated to be independent of surgical timing with DOAC-taking hip fractures [13], which echoes our results. The transfusion rate was in the range reported in other studies (18% [13], 37% [8], 38% [15] and 54% [12]), and was not related to surgical timing, as has been previously demonstrated in the United Kingdom [13].…”

Section: Discussionsupporting

confidence: 83%

“…The study has larger numbers than the existing literature (n = 7 [6], n = 19 [7], n = 27 [8], n = 28 [9], n = 29 [10], n = 33 [16], n = 47 [11], n = 52 [15], n = 54 [12], n = 63 [13] and n = 89 [14]). It also specifically focuses on assessing a dose-response relationship within a cohort taking DOACs; this approach avoids the potential bias of finding a suitable non-DOAC control group and should be considered for future studies.…”

Section: Discussionmentioning

confidence: 93%

“…It seems to be that during the introductory phase of the DOACs, patients with better general health were receiving it. We also believe that the definitions of "early versus late" surgical timing (12,24,36,48 or 72 hrs after admission [25]) are arbitrary, and that time is best investigated as a continuum, without assuming linearity.…”

Section: Discussionmentioning

confidence: 99%

“…The existing literature compares hip fracture groups with matched cohorts not taking anticoagulants [7][8][9][11][12][13][14] or groups' DOACs with other antithrombotics without separate analysis [6,10]. The most common management question asked by clinicians is ''what is the safest window to operate?".…”

Section: Discussionmentioning

confidence: 99%

“…National pharmaceutical subsidies have resulted in a steady increase in usage [5]. The existing literature examining DOAC use in hip fracture is small [6][7][8][9][10][11][12][13][14][15][16], and often focuses on comparing DOAC cohorts with groups not taking them, which results in differences between group comorbidity profiles. The appropriate perioperative management for DOACs in hip fracture has been recently queried [17], with expert opinion suggesting a waiting period of 24-48 hours, based on DOAC half-lives and guidelines for elective surgery [18].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

Tarrant

Catanach

Sarrami

et al. 2020

JCM

View full text Add to dashboard Cite

Timely surgical intervention in hip fracture has been linked to improved outcomes. Direct Oral Anticoagulants (DOACs) are an emerging class of anticoagulants without evidence-based guidelines on surgical timing. This study aims to investigate how DOACs affect surgical timing and hence perioperative outcomes. A retrospective database/registry review was conducted for geriatric hip fracture patients aged 65 and over between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included serious adverse events (SAE), transfusion and postoperative day (POD) 1 haemoglobin (Hb) levels. From a cohort of 3264 patients, 112 admitted subjects were taking DOACs; the annual proportion on DOACs increased over time. Mean time to surgery from last dose (Ts) was 2.2 (±1.0 SD) days. The primary outcome, 30-day mortality, occurred in 16 (14%) patients with secondary outcomes of SAEs in 25 (22%) patients and transfusion in 30 (27%) patients. Ts (days) did not significantly affect 30-day mortality (odds ratio (OR): 1.37, 95% confidence interval (CI): 0.80–2.33; p = 0.248), SAE (hazard ratio (HR): 1.03, 95% CI: 0.70–1.52; p = 0.885), transfusion (OR: 0.72 95% CI: 0.45 to 1.16; p = 0.177) or POD 1 Hb (OR: 1.99, 95% CI: −0.59 to 4.57; p = 0.129). Timing of surgery does not influence common surgical outcomes such as 30-day mortality, SAE, transfusion, and POD1 Hb in patients taking DOACs on admission.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

Tarrant

Catanach

Sarrami

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

Idarucizumab in major trauma patients: a single centre real life experience

Oberladstätter

Voelckel

Bruckbauer

et al. 2019

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Synthesis of the evidence on the impact of pre-operative direct oral anticoagulants on patient health outcomes after hip fracture surgery: rapid systematic review

Mitchell

Jakobs

Halim

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose To synthesise the evidence on the impact of pre-operative direct oral anticoagulants (DOACs) on health outcomes for patients who sustain a hip fracture. Method A rapid systematic review of three databases (MEDLINE, Embase and Scopus) for English-language articles from January 2000 to August 2021 was conducted. Abstracts and full text were screened by two reviewers and articles were critically appraised. Data synthesis was undertaken to summarise health outcomes examined for DOAC users versus a no anticoagulant group. Key information was extracted for study type, country and time frame, population and sample size, type of DOACs, comparator population(s), key definitions, health outcome(s), and summary study findings. Results There were 21 articles identified. Of the 18 studies that examined time to surgery, 12 (57.1%) found DOAC users had a longer time to surgery than individuals not using anticoagulants. Five (83.3%) of six studies identified that DOAC users had a lower proportion of surgery conducted within 48 h Four (40.0%) of ten studies reporting hospital length of stay (LOS) identified a higher LOS for DOAC users. Where reported, DOAC users did not have increased mortality, blood loss, transfusion rates, complication rates of stroke, re-operation or readmissions compared to individuals not using anticoagulants. Conclusions The effect of DOAC use on hip fracture patient health was mixed, although patients on DOACs had a longer time to surgery. The review highlights the need for consistent measurement of health outcomes in patients with a hip fracture to determine the most appropriate management of patients with a hip fracture taking DOACs.

show abstract

Impact of Direct Oral Anticoagulants in Patients With Hip Fractures

Abstract: Objective: To assess the impact of direct oral anticoagulant (DOAC) intake compared with Coumadin (COU) in patients suffering hip fractures (HFs).

Cited by 50 publications

References 32 publications

Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

Direct Oral Anticoagulants and Timing of Hip Fracture Surgery

Idarucizumab in major trauma patients: a single centre real life experience

Synthesis of the evidence on the impact of pre-operative direct oral anticoagulants on patient health outcomes after hip fracture surgery: rapid systematic review

Contact Info

Product

Resources

About