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Time to surgery and complications in hip fracture patients on novel oral anticoagulants: a systematic review

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Early surgery has been consistently demonstrated to reduce complications and mortality in hip fracture patients. There remains no general consensus, however, regarding the optimal time to surgery for hip fracture patients who are on novel oral anticoagulants (NOAC) on admission and its effect on clinical outcomes after surgery. The objective of this review was to assess the effect of preoperative NOAC therapy on time to surgery and postoperative complications in hip fracture patients.

Methods

We performed a systematic review of the literature using the PubMed, Embase, and Cochrane Library electronic databases. Relevant articles were identified and included if they: (i) included patients on NOAC therapy on admission who did not undergo reversal; (ii) included a control group of patients not on any anticoagulation; (iii) included time from admission to surgery; and (iv) included one of the following outcomes: blood transfusion, venous thromboembolism (VTE), stroke, readmission, and mortality.

Results

Nine studies were included with a total of 4,419 patients. There were 414 NOAC patients and 4,005 non-anticoagulated patients. Six of the nine studies found a significant increase in time to surgery for patients on NOAC therapy. Three of the seven studies that reported rates of blood transfusion found a significantly higher incidence of transfusion in patients on NOACs. None of the studies found a significant difference in VTE and stroke. One of the two studies that reported readmissions showed a higher risk of readmission for patients on NOACs. Eight of the nine included studies found no significant difference in postoperative mortality rates between the NOAC and control groups, with the remaining study finding a higher mortality rate only in patients on NOAC therapy who underwent fixation and not those who underwent arthroplasty.

Conclusions

These mixed findings suggest that delay to surgery may not be warranted in the urgent surgical setting of patients on NOAC therapy who sustain hip fractures.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 9th Floor, New York, NY, 10029, US

    Zoe B. Cheung, Ryan Xiao & David A. Forsh

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  1. Zoe B. Cheung
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  2. Ryan Xiao
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  3. David A. Forsh
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Corresponding author

Correspondence to Zoe B. Cheung.

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Conflict of interest

Dr. Forsh has financial relationships with Stryker (paid consultant). None of the other authors have any financial interests or affiliations with institutions, organizations, or companies relevant to the manuscript. None of the authors received payment or funding support in kind for any aspect of the submitted work.

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IRB approval was not required for the submitted work at our institution.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Cheung, Z.B., Xiao, R. & Forsh, D.A. Time to surgery and complications in hip fracture patients on novel oral anticoagulants: a systematic review. Arch Orthop Trauma Surg 142, 633–640 (2022). https://doi.org/10.1007/s00402-020-03701-2

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  • DOI: https://doi.org/10.1007/s00402-020-03701-2

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