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  • Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre

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Surgery
Research
Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre
  1. Barry Mullins1,
  2. Harold Akehurst1,
  3. David Slattery2,
  4. Tim Chesser1
  1. 1 Trauma and Orthopaedics, Southmead Hospital, Bristol, UK
  2. 2 Trauma and Orthopaedics, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
  1. Correspondence to Tim Chesser; Tim.Chesser{at}nbt.nhs.uk

Abstract

Objective To determine whether not waiting for the elimination of direct oral anticoagulants (DOACs) has an effect on the amount of perioperative bleeding in patients who undergo operative treatment of a hip fracture.

Design Observation, retrospective case–control study.

Setting A single UK major trauma centre.

Participants Patients who sustained a hip fracture were identified using the National Hip Fracture Database (NHFD). All those found to be taking a DOAC at the time of fracture were identified (n=63). A matched group not taking a DOAC was also identified from the NHFD (n=62).

Main outcome Perioperative drop in haemoglobin concentration.

Results There was no relationship between admission to operation interval and perioperative change in haemoglobin concentration in patients taking DOACs (regression coefficient=−0.06 g/L/hour; 95% CI −0.32–0.20; p=0.64). No relationship was found between the time from admission to operation interval and the probability of transfusion (OR=0.94; 95% CI 0.85 to 1.90; p=0.16) or reoperation (OR=1.04; 95% CI 0.93 to 1.16; p=0.49). One mortality was recorded in the DOAC group within 30 days of admission, and this compared with five in the matched group of patients (p=0.2).

Conclusions Delaying surgery in patients who sustain a hip fracture who are taking a DOAC drug has not been shown to reduce perioperative bleeding or affect their mortality in this study.

  • hip fractures
  • anticoagulants
  • blood transfusion
  • postoperative complications
  • perioperative care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-020625

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    Footnotes

    • Contributors BM, HA: study design, data gathering and analysis, creation and editing of manuscript. DS: study design, data gathering and analysis, editing of manuscript. TC: study design, analysis, editing of manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was conducted in line with low risk ethical protocols at our institution as no patient-identifying information was recorded and data were retrieved from existing medical records.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data for this project are owned by the NHS Trust in which the study was conducted.