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Should patients treated with oral anti-coagulants be operated on within 48 h of hip fracture?

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Abstract

To investigate if patients treated with oral anticoagulants (OAC) have delayed surgical intervention (more than 48 h) compared to patients without OAC therapy, and if there is an impact to surgery timing on hospitalization length and mortality. A retrospective cohort study of all patients aged over 65 registered with a new diagnosis of hip fracture who underwent surgery in one of the general hospitals run by Clalit, Israel between 01/01/2014 and 31/12/2017. Data was retrieved for patient demographics, OAC treatment, and Charlson comorbidity index. 5828 patients were operated for hip fractures, mean age was 82.8 years (65–108), 4013 (68.8%) were female. 415 were treated with direct oral anticoagulants (DOACs) (7.1%) and 311 with warfarin (5.3%) prior to their hospitalization. Patients taking OAC were less likely to be operated within 48 h from arrival to the hospital compared to patients not receiving OAC. The 30 day mortality was 4.2% among patients not receiving OAC, 6.0% among patients taking DOACs and 10.0% among patients receiving warfarin (p < 0.001). Adjusted odds ratio for mortality at 30 day among patients taking DOACs was similar to patients who didn't take OAC. (OR 1.0, CI 0.7, 1.6). The 30 day mortality rate of patients who were receiving OAC (either DOACs or warfarin) was not significantly different whether patients were operated within 48 h or not. Mortality rate was highest among patients taking warfarin. For patients who received DOACs, operation within 48 h wasn't associated with lower mortality rate. In these patients it seemed reasonable to adjust surgery time according to patients' characteristics and needs.

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Authors and Affiliations

  1. Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel

    Michal Shani & Alex Lustman

  2. Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Michal Shani & Alex Lustman

  3. Hospital Division, Clalit Health Services Headquarter, Tel Aviv, Israel

    Michal Shani & Rina Yahalom

  4. Community Division, Clalit Health Services Headquarter, Tel Aviv, Israel

    Doron Comaneshter, Arnon Cohen & Alex Lustman

  5. Wolfson Medical Center, Hulon, Israel

    Keren Holtzman

  6. Thrombosis and Hemoatasis Unit, Institute of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

    Dorit Blickstein

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  1. Michal Shani
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  2. Rina Yahalom
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All authors had substantial contributions to the conception and the design of the work and interpretation of data. All authors have approved the submitted version

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Correspondence to Michal Shani.

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The study was approved by the ethics committee of Meir Medical Center, Kfar Saba, Israel.

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Shani, M., Yahalom, R., Comaneshter, D. et al. Should patients treated with oral anti-coagulants be operated on within 48 h of hip fracture?. J Thromb Thrombolysis 51, 1132–1137 (2021). https://doi.org/10.1007/s11239-020-02261-x

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  • DOI: https://doi.org/10.1007/s11239-020-02261-x

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