Early versus delayed surgery for hip fragility fractures in patients treated with direct oral anticoagulants.

Abstract

Delaying surgical treatment for hip fragility fractures increases mortality, but early intervention in patients treated with direct oral anticoagulant (DOAC) may increase the risk of perioperative blood loss due to residual drug activity. This study aimed to evaluate the effect of the timing of hip fragility fractures surgeries in patients treated with DOAC. We retrospectively reviewed all records of DOAC-treated patients who underwent surgery for hip fragility fractures between 2011 and 2019. They were divided into three groups according to time to surgery since admission to the emergency room (ER), ≤ 24, 24-48, and ≥ 48h. Blood loss, peri and postoperative complications, readmissions, and short- and long-term mortality were compared between groups. Of the 171 suitable patients (59 males and 112 females), 32 (18.7%) were in the ≤ 24h group, 93 (54.4%) in the 24-48h group, and 46 (26.9%) in the ≥ 48h group. Timing of surgery did not affect blood loss, as indicated by changes in pre- and postoperative hemoglobin levels (p = 0.089) and proportion of perioperatively administered packed cells (p = 0.949). There was a trend towards increased 30-day mortality in the ≥ 48h group compared to the 24-48h and ≤ 24h groups (13.0, 4.3 and 3.1%, respectively. p = 0.099), and a trend towards increased 90day mortality (6.5, 3.2, and 0%, respectively. p = 0.298). Early surgery did not increase perioperative blood loss. Delayed surgery ≥ 48h of patients receiving DOAC who underwent surgery for hip fragility fractures showed a trend towards increased 30day and 90day mortality.