Emerging Barrier to Timely Care of Hip Fracture Patients: A Prospective Study of Direct Oral Anticoagulation and Time to Surgery

Abstract

Introduction: Rapid surgical management of hip fracture patients is critical to reduce morbidity and mortality. These patients may be anti-coagulated and the new direct oral anticoagulants (DOAC) may introduce delays to treatment. Our purpose was to examine the impact of these DOAC on time to surgical management for hip fracture patients.Methods: A prospective audit of 55 consecutive operative hip fracture patients examined time from diagnosis to surgery. Indications for anticoagulation were recorded.Results: Time to surgery for the DOAC group was 66±16 hours, versus 38±21 and 25±19 hours for warfarin and control groups, respectively (P<0.05). Anticoagulation was for atrial fibrillation in 93%.Conclusion: Patients on DOAC faced significant delays to surgery. Given that both DOAC use and incidence of hip fracture are expected to rise, this presents a barrier to optimized care in this vulnerable group.