The effectiveness and safety of direct oral anticoagulants compared to conventional pharmacologic thromboprophylaxis in hip fracture patients: A systematic review and meta-analysis of randomized controlled trials

Abatzis-Papadopoulos, Manolis; Tigkiropoulos, Konstantinos; Nikas, Spyridon; Papoutsis, Ioakeim; Kostopoulou, Olympia; Stavridis, Kyriakos; Karamanos, Dimitrios; Lazaridis, Ioannis; Saratzis, Athanasios

doi:10.1016/j.otsr.2022.103364

Cited by 13 publications

(1 citation statement)

References 22 publications

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“…With a favorable safety profile, decreased risk of major bleeding, and no need for routine drug monitoring or dietary regulation, DOAC use has increased dramatically at the expense of VKAs since their introduction to clinical practice in 2010 ( 24 , 25 ). DOACs have also shown comparable outcomes to low-molecular-weight heparin (LMWH) in the setting of hip fractures ( 26 ). In 2015, DOACs accounted for 56.5% of all oral anticoagulant prescriptions and are now the anticoagulant of choice for many patients with atrial fibrillation or a history of stroke/transient ischemic attack (TIA) ( 27 ).…”

Section: Introductionmentioning

confidence: 99%

Review of perioperative outcomes and management of hip fracture patients on direct oral anticoagulants

Wall

Mitchell

et al. 2023

EFORT Open Reviews

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Anticoagulation use is common in elderly patients presenting with hip fractures and has been shown to delay time to surgery (TTS). Delays in operative treatment have been associated with worse outcomes in hip fracture patients. Direct oral anticoagulants (DOACs) comprise a steadily increasing proportion of all oral anticoagulation. Currently, no clear guidelines exist for perioperative management of hip fracture patients taking DOACs. DOAC use is associated with increased TTS, with delays frequently greater than 48 h from hospital presentation. Increased mortality has not been widely demonstrated in DOAC patients, despite increased TTS. Timing of surgery was not found to be associated with increased risk of transfusion or bleeding. Early surgery appears to be safe in patients taking DOACs presenting with a hip fracture, but is not currently widely accepted due to factors such as site-specific anesthesiologic protocols that periodically delay surgery. Direct oral anticoagulant use should not routinely delay surgical treatment in hip fracture patients. Surgical strategies to limit blood loss should be considered and include efficient surgical fixation, topical application of hemostatic agents, and the use of intra-operative cell salvage. Anesthesiologic strategies have utility in minimizing risk and a collaborative effort to minimize blood loss should be undertaken by the surgeon and anesthesiologist. Anesthesia team interventions include considerations regarding positioning, regional anesthesia, permissive hypotension, avoidance of hypothermia, judicious administration of blood products, and the use of systemic hemostatic agents.

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Section: Introductionmentioning

confidence: 99%

Review of perioperative outcomes and management of hip fracture patients on direct oral anticoagulants

Wall

Mitchell

et al. 2023

EFORT Open Reviews

View full text Add to dashboard Cite

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Bibliometric and visualized analysis on hip fracture surgery and venous thromboembolism

Wang,

et al. 2024

Heliyon

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Ongoing refinement remains key in dealing with shifting challenges in traumatological patient care

Haubruck

Heller

2023

Orthopaedics & Traumatology: Surgery & Research

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The effectiveness and safety of direct oral anticoagulants compared to conventional pharmacologic thromboprophylaxis in hip fracture patients: A systematic review and meta-analysis of randomized controlled trials

Cited by 13 publications

References 22 publications

Review of perioperative outcomes and management of hip fracture patients on direct oral anticoagulants

Review of perioperative outcomes and management of hip fracture patients on direct oral anticoagulants

Bibliometric and visualized analysis on hip fracture surgery and venous thromboembolism

Ongoing refinement remains key in dealing with shifting challenges in traumatological patient care

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