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Open Access 01-12-2023 | Direct Oral Anticoagulant | Research

Propensity matched analysis examining the effect of passive reversal of direct oral anticoagulants on blood loss and the need for transfusions among traumatic geriatric hip fractures

Authors: Richard Meinig, Stephanie Jarvis, Kristin Salottolo, Nnamdi Nwafo, Patrick McNair, Paul Harrison, Steven Morgan, Therese Duane, Bradley Woods, Michelle Nentwig, Michael Kelly, David Cornutt, David Bar-Or

Published in: European Journal of Medical Research | Issue 1/2023

Abstract

Background

Reversal of direct oral anticoagulants (DOACs) is currently recommended prior to emergent surgery, such as surgical intervention for traumatic geriatric hip fractures. However, reversal methods are expensive and timely, often delaying surgical intervention, which is a predictor of outcomes. The study objective was to examine the effect of DOAC reversal on blood loss and transfusions among geriatric patients with hip fractures.

Methods

This retrospective propensity-matched study across six level I trauma centers included geriatric patients on DOACs with isolated fragility hip fractures requiring surgical intervention (2014–2017). Outcomes included: intraoperative blood loss, intraoperative pRBCs, and hospital length of stay (HLOS).

Results

After matching there were 62 patients (31 reversed, 31 not reversed), 29 patients were not matched. The only reversal method utilized was passive reversal (waiting ≥ 24 hours for elimination). Passively reversed patients had a longer time to surgery (mean, 43 vs. 18 hours, p < 0.01). Most patients (92%) had blood loss (90% passively reversed, 94% not reversed); the median volume of blood loss was 100 mL for both those groups, p = 0.97. Thirteen percent had pRBCs transfused (13% passively reversed and 13% not reversed); the median volume of pRBCs transfused was 525 mL for those passively reversed and 314 mL for those not reversed, p = 0.52. The mean HLOS was significantly longer for those passively reversed (7 vs. 5 days, p = 0.001).

Conclusions

Passive DOAC reversal for geriatric patients with isolated hip fracture requiring surgery may be contributing to delayed surgery and an increased HLOS without having a significant effect on blood loss or transfusions. These data suggest that passive DOAC reversal may not be necessary prior to surgical repair of isolated hip fracture.

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Title: Propensity matched analysis examining the effect of passive reversal of direct oral anticoagulants on blood loss and the need for transfusions among traumatic geriatric hip fractures
Authors: Richard Meinig
Stephanie Jarvis
Kristin Salottolo
Nnamdi Nwafo
Patrick McNair
Paul Harrison
Steven Morgan
Therese Duane
Bradley Woods
Michelle Nentwig
Michael Kelly
David Cornutt
David Bar-Or
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Direct Oral Anticoagulant
Direct Oral Anticoagulant
ß-Blockers
Published in: European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-023-01053-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Propensity matched analysis examining the effect of passive reversal of direct oral anticoagulants on blood loss and the need for transfusions among traumatic geriatric hip fractures

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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