Early Hip Fracture Surgery in Patients Taking Direct Oral Anticoagulants Improves Outcome
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (n = 340) | Coumarins (n = 26) | DOAC (n = 59) | No Anticoagulation (n = 255) | |||||
---|---|---|---|---|---|---|---|---|
Demographics | Mean | SD | Mean | SD | Mean | SD | Mean | SD |
Age | 80 | 12 | 85 | 8 | 84 | 8 | 79 | 12 |
Weight (kg) | 69 | 17 | 71 | 12 | 68 | 14 | 68 | 18 |
Height (cm) | 167 | 10 | 168 | 10 | 168 | 8 | 167 | 9.7 |
Male/Female | 116/224 (34/66%) | 9/17 (35/65%) | 18/41 (31/69%) | 89/166 (35/65%) | ||||
Trauma | # | % | # | % | # | % | # | % |
Fall from standing | 296 | 87% | 23 | 88% | 51 | 86% | 222 | 87% |
High energy | 4 | 1% | 0 | 0% | 0 | 0% | 4 | 2% |
Other low energy | 14 | 4% | 1 | 4% | 4 | 7% | 9 | 4% |
Fall from bicycle | 15 | 4% | 0 | 0% | 3 | 5% | 12 | 5% |
Fall from stairs | 9 | 3% | 2 | 8% | 0 | 0% | 7 | 3% |
Unspecified | 2 | 0% | 0 | 0% | 1 | 2% | 1 | 0% |
Operation | # | % | # | % | # | % | # | % |
Osteosynthesis | 187 | 55% | 14 | 54% | 29 | 49% | 145 | 57 |
Hemiarthroplasty | 153 | 45% | 12 | 46% | 30 | 51% | 110 | 43 |
Timing of the operation | ||||||||
Daytime (08–16 h) | 225 | 66% | 18 | 69% | 46 | 78% | 161 | 63% |
Evening (16–00 h) | 84 | 25% | 6 | 23% | 10 | 17% | 68 | 26% |
Night (00–08 h) | 31 | 9% | 2 | 8% | 3 | 5% | 26 | 10% |
Mean | SD | Mean | SD | Mean | SD | Mean | SD | |
Operating Time (min) | 66 | 62 | 67 | 66 | ||||
Comorbidities | Mean | SD | SD | SD | ||||
ASA Score | 2.8 | 3.3 | 0.55 | 3.1 | 0.87 | 2.7 | 0.97 | |
Type of Comorbidity: | # | % | # | % | # | % | # | % |
Cardiovascular | 304 | 89% | 26 | 100% | 59 | 100% | 219 | 86% |
Diabetes | 77 | 23% | 3 | 12% | 11 | 19% | 63 | 25% |
Pulmonary | 84 | 25% | 7 | 27% | 12 | 20% | 65 | 25% |
Neurological | 196 | 58% | 14 | 53% | 39 | 66% | 143 | 56% |
Rheumatological | 18 | 5% | 1 | 4% | 2 | 3% | 15 | 6% |
History of cancer | 69 | 20% | 5 | 19% | 8 | 14% | 56 | 22% |
Medication | ||||||||
Antithrombotics | 116 | 34% | 1 | 3% | 8 | 14% | 107 | 41% |
Admission Labs | Mean | Mean | SD | Mean | SD | Mean | SD | |
Creatine | 1.1 | 1.3 | 0.5 | 1.0 | 0.3 | 1.1 | 0.5 | |
C-Reactive Protein | 18 | 16 | 32 | 17 | 27 | 18 | 34 | |
Quick | 87 | 36 | 22 | 65 | 23 | 97 | 16 | |
INR | 1.3 | 2.4 | 0.9 | 1.4 | 0.5 | 1.1 | 1.7 | |
ApTT | 29 | 35 | 6.3 | 30 | 7.1 | 28 | 11 | |
Fibrinogen | 348 | 334 | 110 | 327 | 92 | 354 | 111 | |
White Blood cell Count | 10.6 | 12.0 | 6.3 | 9.9 | 3.9 | 10.6 | 3.9 | |
Hemoglobin | 12.5 | 12.4 | 2.0 | 12.4 | 1.7 | 12.5 | 1.7 | |
Thrombocyte count | 243 | 216 | 85 | 236 | 95 | 247 | 79 |
Surgery related: | 27 |
Implant malpositioning | 3 |
Secondary dislocation of bipolar femoral head and fracture displacement | 4 |
Intraoperative bleeding | 1 |
Intraoperative periprosthetic fracture | 4 |
Postoperative hematoma | 2 |
Surgical wound infection | 9 |
Persistent wound drainage | 3 |
Nerve palsy | |
| 1 |
| 0 |
Medically related: | 205 |
Pneumonia, lung disease exacerbation | 39 |
Cardiovascular events, CV disease exacerbation | 42 |
Deep venous thrombosis | 1 |
Pulmonary embolism | 1 |
Urinary tract infection | 33 |
Acute kidney failure | 24 |
Liver/gallbladder/pancreas/ileus dysregulation | 7 |
Pressure sores | 6 |
Delirium | 21 |
GI bleeding | 8 |
Neurological event, neurological disease exacerbation | 8 |
Sepsis | 3 |
Other (bursitis, dehydration, diabetic complications, transfusion reaction, acute limb ischemia, severe postoperative pain) | 12 |
(1) | |||
---|---|---|---|
DOAC | No Anticoagulation | p | |
Transfusion rate (%) | 30.6% | 32.2% | 0.8759 |
Hemoglobin change (g/dL) | 2.4 + 1.3 | 2.7 +1.4 | 0.1698 |
Length of postoperative stay (days) | 15.1 + 11.7 | 14.4 + 10.2 | 0.9838 |
Time to surgery (hours) | 28.63 + 12.28 | 21.35 + 14.93 | <0.0001 |
Patients with complications (%)
Medical complications (#) | 37.3% 4 (6.8%) 6 (10%) 33 (56%) | 41.2% 14 (5.5%) 18 (7%) 154 (60%) | 0.6596 |
Revisions total (%) Revision same stay
| 7 (11.8%) 2 (3.4%) 4 3 0 | 13 (5.1%) 11 (4.3%) 2 8 3 | 0.0726 |
(2) | |||
<24 h | 24–48 h | p | |
Transfusion rate (%) | 50 (25.9%) | 58 (39.45%) | 0.0138 |
Hemoglobin change (g/dL) | 2.69 + 1.37 | 2.630 + 1.364 | 0.7144 |
Length of postoperative stay (days) | 13.7 + 10.0 | 15.8 + 11.1 | 0.0711 |
Complications general (%) | 35.1% | 49.0% | 0.0108 |
Complications in DOAC patients (%) | 9.3% | 28.8% | <0.0001 |
(3) | |||
<24 h | 24–48 h | p | |
Transfusion rate (%) | 17.7% | 38.1% | 0.2179 |
Hemoglobin change (g/dL) | 2.58 + 1.1 | 2.39 + 1.4 | 0.6077 |
Length of postoperative stay (days) | 10.8 + 8.3 | 16.8 + 12.4 | 0.0167 |
Complications (%) | 29.4% | 40.5% | 0.5561 |
Revisions (%) | 5.9% | 11.9% | 0.6622 |
Control | DOAC | AVK | |
---|---|---|---|
Hematoma | 2 (0.7%) | 4 (6.7%) | 2 (7.7%) |
Infection and wound healing problems | 8 | 3 | 3 |
Pseudarthrosis, avascular necrosis | 3 | 0 | 0 |
Total | 13 | 7 | 5 |
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Devlieger, B.K.; Rommens, P.M.; Baranowski, A.; Wagner, D. Early Hip Fracture Surgery in Patients Taking Direct Oral Anticoagulants Improves Outcome. J. Clin. Med. 2024, 13, 4707. https://doi.org/10.3390/jcm13164707
Devlieger BK, Rommens PM, Baranowski A, Wagner D. Early Hip Fracture Surgery in Patients Taking Direct Oral Anticoagulants Improves Outcome. Journal of Clinical Medicine. 2024; 13(16):4707. https://doi.org/10.3390/jcm13164707
Chicago/Turabian StyleDevlieger, Benjamin K., Pol M. Rommens, Andreas Baranowski, and Daniel Wagner. 2024. "Early Hip Fracture Surgery in Patients Taking Direct Oral Anticoagulants Improves Outcome" Journal of Clinical Medicine 13, no. 16: 4707. https://doi.org/10.3390/jcm13164707