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The impact of antithrombotic therapy on surgical delay and 2-year mortality in older patients with hip fracture: a prospective observational study

European Geriatric Medicine volume 11, pages 555–561 (2020)Cite this article

Key summary points

AbstractSection Aim

Effect of oral anticoagulant and antiplatelet treatment in older patients requiring surgical treatment for hip fracture.

AbstractSection Findings

The oral anticoagulant or high-dose antiplatelet treatments are significantly associated with an increase in the waiting time to surgery and the mean length of stay. Those treatments also showed a higher rate of some immediate postsurgical medical complications.

AbstractSection Message

Hip fracture patients following previous oral anticoagulant treatment have a higher 2-year mortality rate, but we could not demonstrate an effect on early mortality.

Abstract

Purpose

To analyze the associations of oral anticoagulant and antiplatelet treatments in older patients requiring surgical treatment for hip fracture with mortality, length of stay, waiting time to surgery and postsurgical immediate complications.

Methods

A prospective observational study, including surgically treated hip fracture patients aged 65 years and older. We analyzed admission status variables, and time to surgery, length of stay and immediate surgical and medical complications. We recorded a 2-year survival follow-up.

Results

Of the 237 patients studied, 32.5% received antiplatelet treatment and 17.7% received oral anticoagulant treatment. The overall 2-year mortality was 29.1%. The 2-year mortality rate reached the 33.8% for antiplatelet-treated patients (n.s.) and 45.2% for oral anticoagulated patients (p = 0.011). The length of stay increased significantly associated with the oral anticoagulant or high-dose antiplatelet treatment (p < 0.001). The same happened for the time to surgery (p < 0.001), but no delay was observed for patients with low-dose antiplatelet treatment. Oral anticoagulated and antiplatelet-treated patients had a higher Charlson comorbidity index (p = 0.004, p = 0.019) and ASA score (p = 0.006, p = 0.011). Those treatments were also associated with a higher rate of some immediate postsurgical medical complications. We found a relationship between low hemoglobin at admission and high-dose antiplatelet treatment (p = 0.044).

Conclusions

Hip fracture patients following previous oral anticoagulant treatment have a higher 2-year mortality rate. The oral anticoagulant or high-dose antiplatelet treatments are significantly associated with an increase in the length of stay, related to time to surgery, but we could not demonstrate an effect on early mortality.

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Data availability

The data supporting this study are available from the corresponding author upon reasonable request.

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Funding

No specific funding for this study and its publication was obtained.

Author information

Affiliations

  1. Trauma and Orthopedic Surgery Department, University Hospital of Salamanca, Salamanca, Spain

    Samuel López, David Pescador & Juan F. Blanco

  2. Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain

    Samuel López, Carmen da Casa, Carmen Pablos-Hernández, David Pescador, Agustín Díaz-Álvarez & Juan F. Blanco

  3. Orthogeriatric Unit, University Hospital of Salamanca, Salamanca, Spain

    Carmen Pablos-Hernández

  4. Anesthesia Department, University Hospital of Salamanca, Salamanca, Spain

    Agustín Díaz-Álvarez

  5. Primary Healthcare, “Miguel Armijo” Healthcare Center, Salamanca, Spain

    Nuria Asensio

Authors
  1. Samuel López
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  2. Carmen da Casa
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  3. Carmen Pablos-Hernández
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  4. David Pescador
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  5. Agustín Díaz-Álvarez
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  7. Juan F. Blanco
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Contributions

SL, CdaC, CPH, DP and NA collected patient data and contributed to the database fill-in process. CdaC and ADA performed data analysis. CdaC and JB draft the work. JFB designed the study and was responsible for data interpretation. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Juan F. Blanco.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human participants

Whole study was conducted following the Declaration of Helsinki and previously approved by the ethics committee for clinical research (CEIm) of the University Hospital of Salamanca (cod. ref. 2020 02 427).

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Informed consent was obtained from all individual participants included in the study.

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López, S., da Casa, C., Pablos-Hernández, C. et al. The impact of antithrombotic therapy on surgical delay and 2-year mortality in older patients with hip fracture: a prospective observational study. Eur Geriatr Med 11, 555–561 (2020). https://doi.org/10.1007/s41999-020-00293-3

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  • DOI: https://doi.org/10.1007/s41999-020-00293-3

Keywords

  • Antithrombotic
  • Anticoagulant
  • Antiplatelet
  • Hip fracture
  • Mortality