Operative treatment of distal radial fractures under vitamin Kantagonist or DOAC : Is preoperative interruption of these drugs necessary?

Abstract

Scientific data on emergency operations during ongoing treatment with vitamin Kantagonists or with direct oral anticoagulants (DOAC) are lacking, because interruption or bridging of this treatment is routinely performed for up to several days. To reduce time delays and to simplify this procedure, we perform operations of distal radial fractures immediately and without interruption of antithrombotic medication. For this retrospective and monocentric study, we included only patients with distal radial fractures treated within 12 h after diagnosis with open reduction and volar plating and who received anticoagulation with a vitamin Kantagonist or DOAC. Primary aim of the study was evaluation of specific complications, such as revision due to bleeding or hematoma formation and secondary aims were thromboembolic events or infections. The endpoint was 6weeks after the operation. Between 2011 and 2020, 907consecutive patients with distal radial fractures were operatively treated. Of these, 55patients met the inclusion criteria. The mean age was 81.5Jahre (63-94 years) and women (n = 49) were primarily affected. All operations were performed without tourniquets. With a study endpoint 6weeks after operation, no revisions were performed for bleeding, hematoma, or infection and primary wound healing was assessed for all patients. One revision was performed for fracture dislocation. Thromboembolic events were also not documented. In this study the treatment of distal radial fractures within 12 h and without interruption of antithrombotic treatment was not associated with any imminent systemic complications. This applies to both vitamin Kantagonists and DOAC; however, higher case numbers must confirm our results.