Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Internal Medicine B, Lady Davis Carmel Medical Center, Haifa, Israel.
Thromb Res. 2020 May;189:48-54. doi: 10.1016/j.thromres.2020.03.002. Epub 2020 Mar 3.
Hip fracture is common among the elderly and is associated with increased morbidity and mortality, particularly when surgery is delayed. Direct oral anticoagulants (DOACs) use might increase bleeding and postpone hip repair surgery. We aimed to assess the association between preoperative DOACs use and adverse outcomes in elderly patients with hip fracture.
This retrospective cohort study included all elderly patients (≥65 years), from the district of Haifa and Western Galilee, Israel, who underwent hip repair surgery for hip fracture between 2014 and 2018. Regression models with adjustment for propensity score were used to assess the association with all-cause mortality and other adverse outcomes.
A total of 3418 patients with hip fracture were included of whom 163 (4.8%) were vitamin K antagonists (VKAs) users and 247 (7.2%) were DOCAs users. Propensity score adjusted models revealed that, compared to no anticoagulants use, DOACs use were independently associated with decreased risk of 30-day and 90-day mortality; HR 0.38 (95% CI, 0.17-0.88) and 0.47 (0.27-0.82), respectively. No significant associations were detected between VKAs use and all-cause mortality, compared to no anticoagulants use. DOACs and VKAs had significantly longer waiting time for hip repair surgery, and longer stay in hospital. DOACs and VKAs users had a non-significant higher estimated intraoperative bleeding. However, only VKAs users required a significantly higher number of blood transfusions.
Albeit being associated with longer waiting time for surgery and longer hospitalization, DOACs use appears to be associated with reduced risk of mortality among elderly patients with hip fracture.
髋部骨折在老年人中很常见，与发病率和死亡率增加有关，尤其是当手术被推迟时。直接口服抗凝剂（DOACs）的使用可能会增加出血并推迟髋关节修复手术。我们旨在评估术前 DOACs 使用与老年髋部骨折患者不良结局之间的关系。
这项回顾性队列研究纳入了来自以色列海法和加利利西部地区的所有老年患者（≥65 岁），他们在 2014 年至 2018 年间接受了髋部骨折修复手术。使用调整倾向评分的回归模型来评估与全因死亡率和其他不良结局的关系。
共纳入 3418 例髋部骨折患者，其中 163 例（4.8%）为维生素 K 拮抗剂（VKAs）使用者，247 例（7.2%）为 DOACs 使用者。经倾向评分调整的模型显示，与未使用抗凝剂相比，DOACs 使用与 30 天和 90 天死亡率降低独立相关；风险比（HR）分别为 0.38（95%置信区间，0.17-0.88）和 0.47（0.27-0.82）。与未使用抗凝剂相比，VKAs 使用与全因死亡率之间未发现显著相关性。与未使用抗凝剂相比，DOACs 和 VKAs 髋关节修复手术的等待时间明显更长，住院时间也更长。DOACs 和 VKAs 使用者术中估计出血量较高，但无统计学意义。然而，只有 VKAs 使用者需要输血量明显更高。
尽管 DOACs 使用与手术等待时间延长和住院时间延长有关，但它似乎与老年髋部骨折患者的死亡率降低相关。
