Objective:

To evaluate the safety and outcomes of early hip fracture surgery in patients taking direct oral anticoagulants (DOACs).

Approach:

Key Findings:

• Median hemoglobin decrease was 0.6 mmol/L in early surgery vs 0.9 mmol/L in delayed surgery.
• Early surgery was associated with a 0.25 mmol/L lower hemoglobin decrease compared to delayed surgery.
• No significant differences in blood transfusions or postoperative anemia between the two groups.
• Early surgery resulted in a shorter median hospital stay (6 days vs 8 days).
• In-hospital mortality was 1% for early surgery vs 2% for delayed surgery; 30-day mortality was 3% vs 5%.

Interpretation:

Early surgery in patients on DOACs does not lead to greater hemoglobin decrease and is linked to shorter hospital stays, indicating its safety.

Limitations:

• Retrospective design may introduce bias.
• Lack of data on timing of last DOAC dose and serum levels.
• Missing data on comorbidities, fracture type, and functional status.

Conclusion:

Surgery within 24 hours for hip fracture patients on DOACs is safe and does not increase the risk of significant hemoglobin decrease.

Sources:

• JBJS Open Access
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