Use of Direct Oral Anticoagulants Among Patients With Hip Fracture Is Not an Indication to Delay Surgical Intervention

医学 围手术期 共病 髋部骨折 外科 队列 回顾性队列研究 肺栓塞 血栓形成 静脉血栓形成 并发症 内科学 骨质疏松症
作者
Devon T. Brameier,Eric H. Tischler,Taylor D. Ottesen,Michael F. McTague,Paul Appleton,Mitchel B. Harris,Michael J. Weaver,Nishant Suneja
出处
期刊:Journal of Orthopaedic Trauma [Ovid Technologies (Wolters Kluwer)]
卷期号:38 (3): 148-154 被引量:1
标识
DOI:10.1097/bot.0000000000002753
摘要

OBJECTIVES: To compare outcomes in patients on direct oral anticoagulants (DOACs) treated within 48 hours of last preoperative dose with those with surgical delays >48 hours. METHODS: Design: Retrospective cohort study. Setting: Three academic Level 1 trauma centers. Patient Selection Criteria: Patients 65 years of age or older on DOACs before hip fracture treated between 2010 and 2018. Patients were excluded if last DOAC dose was >24 hours before admission, patient suffered from polytrauma, and/or delay to surgery was not attributed to DOAC. Outcome Measures and Comparisons: Primary outcome measures were the postoperative complication rate as determined by diagnosis of deep venous thrombosis or pulmonary embolus, wound breakdown, drainage, or infection. Secondary outcomes included transfusion requirement, perioperative bleeding, length of stay, reoperation rates, readmission rates, and mortality. RESULTS: Two hundred five patients were included in this study, with a mean cohort age of 81.9 years (65–100 years), 64% were (132/205) female, and a mean Charlson Comorbidity Index of 6.4 (2–20). No significant difference was observed among age, sex, Charlson Comorbidity Index, or fracture pattern between cohorts ( P > 0.05 for all comparisons). Seventy-one patients had surgery <48 hours after final preoperative DOAC dose; 134 patients had surgery >48 hours after. No significant difference in complication rate between the 2 cohorts was observed ( P = 0.30). Patients with delayed surgical management were more likely to require transfusion (OR 2.39, 95% CI, 1.05–5.44; P = 0.04). Patients with early surgical management had significantly shorter lengths of stay (5.9 vs. 7.6 days, P < 0.005). There was no difference in estimated blood loss, anemia, reoperations, readmissions, 90-day mortality, or 1-year mortality ( P > 0.05 for all comparisons). CONCLUSIONS: Geriatric patients with hip fracture who underwent surgical management within 48 hours of their last preoperative DOAC dose required less transfusions and had decreased length of stay, with comparable mortality and complication rates with patients with surgery delayed beyond 48 hours. Providers should consider early intervention in this population rather than adherence to elective procedure guidelines. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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