Outcomes and anticoagulation use for elderly patients that present with an Acute Hip Fracture: multi‐centre, retrospective analysis
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This is the peer reviewed version of the following article: Creeper, K. and Stafford, A. and Reynolds, S. and Samida, S. and P'Ng, S. and Glennon, D. and Seymour, H. et al. 2020. Outcomes and anticoagulation use for elderly patients that present with an Acute Hip Fracture: multi‐centre, retrospective analysis. Internal Medicine Journal, which has been published in final form at https://doi.org/10.1111/imj.15007. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
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Background Hip fractures are a common problem and corrective surgery is recommended within 24hrs. However, most perioperative direct oral anticoagulant (DOAC) guidelines suggest a washout period of 48 hours before major surgery. There is limited data on utility of drug levels. Objective To investigate the effect of DOAC therapy on time to surgery and patient outcomes, and to explore the impact of different pre-operative protocols on surgical delay. Methods A multi-centre, retrospective analysis of all adult patients that presented with acute hip fracture at three tertiary hospitals in Perth, Western Australia was performed. Data was collated from the West Australian hip fracture registry and electronic records. Time to theatre, DOAC levels, bleeding and transfusion rates were compared between sites. Results Of 1240 hip fracture patients 145 (11.8%) were on anticoagulation, with more patients taking a DOAC than warfarin. The time to surgery was significantly longer for those on a DOAC compared to those on warfarin (P = 0.003). There was no difference in bleeding, transfusion requirement or 30-day mortality in patients taking a DOAC compared to those on warfarin. 58 patients (70.7%) had a DOAC level prior to surgery. Of 25 patients who had a level performed within 12 hours of presentation 13 (52%) had result of ≤50ng/mL. Outcomes were similar between sites. Conclusion People on DOAC treatment had a significant delay before corrective surgery compared to those on warfarin. The frequent finding of early DOAC levels <50ng/mL suggests this delay may be unnecessary in a significant proportion of patients.