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Role of DOAC plasma concentration on perioperative blood loss and transfusion requirements in patients with hip fractures

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

There is an ever-increasing number of hip fracture (HF) patients on direct oral anticoagulants (DOAC). The impact of DOAC plasma level prior to HF surgery on perioperative blood loss and transfusion requirements has not been investigated so far.

Materials and methods

In this retrospective study of HF patients on DOACs admitted to the AUVA Trauma Center Salzburg between February 2015 and December 2021. DOAC plasma levels were analysed prior to surgery. Patients were categorized into four DOAC groups: Group A < 30 ng/mL, Group B 30–49 ng/mL, Group C 50–79 ng/mL, and Group D ≥ 80 ng/mL. Haemoglobin concentration was measured upon admission, prior to surgery, after ICU/IMC admission, and on day 1 and 2 post-surgery. Difference in the blood loss via drains, transfusion requirements and time to surgery were compared.

Results

A total of 155 subjects fulfilled the predefined inclusion criteria. The median age of the predominantly female patients was 86 (80–90) years. Haemoglobin concentration in Group D was lower upon admissions but did not reach statistical significance. The decrease in haemoglobin concentration over the entire observation time was comparable between groups. Blood transfusion requirements were significantly higher in Group D compared to Group A and B (p = 0.0043). Time to surgery, intra- and postoperative blood loss via drains were not different among groups.

Conclusion

No strong association between the DOAC plasma levels and perioperative blood loss was detected. Higher transfusion rates in patients with DOAC levels ≥ 80 ng/mL were primarily related to lower admission haemoglobin levels. DOAC concentration measurement is feasible and expedites time to surgery.

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Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Dr. Franz Rehrl Platz 5, 5020, Salzburg, Austria

    Hannah Hofer, Daniel Oberladstätter, Wolfgang Voelckel, Chris Lockie & Herbert Schöchl

  2. Paracelsus Medical University, Salzburg, Austria

    Hannah Hofer

  3. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria

    Daniel Oberladstätter, Christoph J. Schlimp, Johannes Zipperle, Marcin Osuchowski & Herbert Schöchl

  4. Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany

    Oliver Grottke

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  1. Hannah Hofer
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  2. Daniel Oberladstätter
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  3. Christoph J. Schlimp
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  4. Wolfgang Voelckel
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  9. Herbert Schöchl
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Corresponding author

Correspondence to Herbert Schöchl.

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Conflict of interest

H.S. has received honoraria for participation in advisory board meetings for Bayer Healthcare, Boehringer Ingelheim, and TEM International. He has also received speaker fees from Haemonetics and Vifor, and study grants from CSL Behring. C.J.S. has received honoraria for lectures, consultancy, and for participation in advisory board meetings from CSL Behring, Boehringer Ingelheim, Portola, Shinogi, and Octa, as well as research support from TEM Innovation. O.G has received study grants from CSL Behring, Portola, TEM International. The remaining authors do not declare any conflicts of interest.

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All procedures performed in studies were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hofer, H., Oberladstätter, D., Schlimp, C.J. et al. Role of DOAC plasma concentration on perioperative blood loss and transfusion requirements in patients with hip fractures. Eur J Trauma Emerg Surg 49, 165–172 (2023). https://doi.org/10.1007/s00068-022-02041-7

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  • DOI: https://doi.org/10.1007/s00068-022-02041-7

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