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Archives of Orthopaedic and Trauma Surgery

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Open Access 01-02-2020 | Anticoagulant | Trauma Surgery

Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis

Authors: Caroline Hoerlyck, Terence Ong, Merete Gregersen, Else Marie Damsgaard, Lars Borris, Jac Kie Chia, Ying Yi Wendy Yap, Namal Weerasuriya, Opinder Sahota

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2020

Abstract

Introduction

The management of patients with a hip fracture is affected by the use of oral anticoagulants. A cross-sectional analysis was undertaken to investigate health outcome differences in those anticoagulated compared to those not anticoagulated.

Methods

Patients aged 50 years and over presenting to a large university hospital with hip fractures were identified from the service registry. Patient characteristics and health outcomes between those not anticoagulated were compared with those anticoagulated (warfarin and direct oral anticoagulants, DOAC).

Results

200/2307 (9%) patients were anticoagulated. 84% were on warfarin, and the rest a DOAC. Compared to those anticoagulated, there was a higher prevalence of dementia (25% vs. 18%, p = 0.02) and a lower prevalence of cardiovascular disease (54% vs. 78%, p < 0.01), atrial fibrillation (10% vs. 82%, p < 0.01), and polypharmacy (55% vs. 76%, p < 0.01). Renal function was lower in the anticoagulated group. Time to operation for those not anticoagulated and anticoagulated was a median (IQR) of 25 (15) and 27 (18) hours. There was no difference in blood transfusion and hospital mortality. Postoperative complications were similar except a higher rate of renal failure (14% vs. 19%, p = 0.04) and heart failure (1% vs. 5%, p < 0.01), and a longer length of stay [median (IQR): 14 (10) vs. 16 (12) days] in the anticoagulated group. This was no longer significant after adjustment of confounders.

Conclusion

There was no statistically significant difference in health outcomes between those anticoagulated and those not after adjusting for patient characteristics. It was feasible to avoid significant delay in hip fracture surgery in those anticoagulated.

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Title: Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis
Authors: Caroline Hoerlyck
Terence Ong
Merete Gregersen
Else Marie Damsgaard
Lars Borris
Jac Kie Chia
Ying Yi Wendy Yap
Namal Weerasuriya
Opinder Sahota
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Anticoagulant
Direct Oral Anticoagulant
Atrial Fibrillation
Warfarin
Direct Oral Anticoagulant
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03240-5

At a glance: The STEP trials

Springer Medicine

Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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Acknowledgement to Reviewers 2019