Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Center Salzburg, Academic Teaching Hospital, Paracelsus Medical University, Salzburg, Austria.
Paracelsus Medical University, Salzburg, Austria.
J Orthop Trauma. 2019 Jan;33(1):e8-e13. doi: 10.1097/BOT.0000000000001329.
To assess the impact of direct oral anticoagulant (DOAC) intake compared with Coumadin (COU) in patients suffering hip fractures (HFs).
Retrospective cohort analysis.
Level 1 Trauma Center.
Timing of surgical hip fixation.
Three-hundred twenty patients 65 years of age or older with isolated HF were enrolled into the study: 207 (64.7%) without any antithrombotic therapy (no-ATT), 59 (18.4%) on COU, and 54 (16.9%) on DOACs.
Time to surgery, blood loss, mortality, hospital length of stay, red blood cell transfusion, use of reversal agents, and Charlson Comorbidity Index.
Patients on COU and DOACs had a higher Charlson Comorbidity Index compared with the no-ATT group (P < 0.0001). Despite the fact that significantly more patients received reversal agents in the COU group compared with DOAC medication (P < 0.0001), percentage of transfused patients were similar (54.2% vs. 53.7%). Time to surgery was significantly shorter in the no-ATT group when compared with DOAC patients (12-29.5 hours, respectively). No difference in postoperative hemorrhage, intensive care unit length of stay, and mortality was observed between groups.
DOAC medication in HF patients caused long elapse time until surgical repair. We found no evidence of higher bleeding rates in HF patients on DOACs compared with COUs. Earlier HF fixation might be indicated in DOAC patients.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估与华法林（COU）相比，直接口服抗凝剂（DOAC）对髋部骨折（HFs）患者的影响。
回顾性队列分析。
1 级创伤中心。
髋关节固定手术时机。
320 名 65 岁或以上的单纯 HF 患者纳入研究：207 名（64.7%）无任何抗血栓治疗（无 ATT），59 名（18.4%）服用 COU，54 名（16.9%）服用 DOAC。
手术时间、失血量、死亡率、住院时间、红细胞输注、逆转剂使用和 Charlson 合并症指数。
与无 ATT 组相比，服用 COU 和 DOAC 的患者 Charlson 合并症指数更高（P<0.0001）。尽管 COU 组接受逆转剂的患者明显多于 DOAC 组（P<0.0001），但输血患者的比例相似（54.2%比 53.7%）。与 DOAC 患者相比，无 ATT 组的手术时间明显缩短（分别为 12-29.5 小时）。各组之间术后出血、重症监护病房住院时间和死亡率无差异。
HF 患者服用 DOAC 药物会导致手术修复的时间延长。我们没有发现 HF 患者服用 DOAC 比服用 COU 出血率更高的证据。在 DOAC 患者中，可能需要更早地进行 HF 固定。
治疗 III 级。请参阅作者说明以获取完整的证据水平描述。
