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Effect of Direct Oral Anticoagulants on Treatment of Geriatric Hip Fracture Patients: An Analysis of 15,099 Patients of the AltersTraumaRegister DGU
Background and Objectives: The increased use of direct oral anticoagulants (DOACs) results in an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC treatment on perioperative management of hip fracture patients is limited. In this study, we describe the...
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| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Philipps-Universität Marburg
2022
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| Subjects: | |
| Online Access: | PDF Full Text |
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| Summary: | Background and Objectives: The increased use of direct oral anticoagulants (DOACs) results in
an increased prevalence of DOAC treatment in hip fractures patients. However, the impact of DOAC
treatment on perioperative management of hip fracture patients is limited. In this study, we describe
the prevalence of DOAC treatment in a population of hip fracture patients and compare these patients
with patients taking vitamin K antagonists (VKA) and patients not taking anticoagulants. Materials
and Methods: This study is a retrospective analysis from the Registry for Geriatric Trauma (ATR-DGU).
The data were collected prospectively from patients with proximal femur fractures treated between
January 2016 and December 2018. Among other factors, anticoagulation was surveyed. The primary
outcome parameter was time-to-surgery. Further parameters were: type of anesthesia, surgical
complications, soft tissue complications, length of stay and mortality. Results: In total, 11% (n = 1595)
of patients took DOACs at the time of fracture, whereas 9.2% (n = 1325) were on VKA therapy. During
the study period, there was a shift from VKA to DOACs. The time-to-surgery of patients on DOACs
and of patients on VKA was longer compared to patients who did not take any anticoagulation. No
significant differences with regard to complications, type of anesthesia and mortality were found
between patients on DOACs compared to VKA treatment. Conclusion: An increased time-to-surgery
in patients taking DOACs and taking VKA compared to non-anticoagulated patients was found. This
underlines the need for standardized multi-disciplinary orthopedic, hematologic and ortho-geriatric
algorithms for the management of hip fracture patients under DOAC treatment. In addition, no
significant differences regarding complications and mortality were found between DOAC and VKA
users. This demonstrates that even in the absence of widely available antidotes, the safe management
of geriatric patients under DOACs with proximal femur fractures is possible. |
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| Item Description: | Gefördert durch den Open-Access-Publikationsfonds der UB Marburg. |
| Physical Description: | 9 Pages |
| DOI: | 10.3390/medicina58030379 |