Department of Clinical Medicine, University of Bergen, Bergen, Norway.
The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
Eur Geriatr Med. 2020 Aug;11(4):563-569. doi: 10.1007/s41999-020-00319-w. Epub 2020 Jul 23.
The perioperative consequences of direct oral anticoagulants (DOACs) in hip fracture patients are not sufficiently investigated. The primary aim of this study was to determine whether DOAC-users have delayed surgery compared to non-users. Secondarily, we studied whether length of hospital stay, mortality, reoperations and bleeding complications were influenced by the use of DOAC.
The medical records of 314 patients operated for a hip fracture between 2016 and 2017 in a single trauma center were assessed. Patients aged < 60 and patients using other forms of anticoagulation than DOACs were excluded. Patients were followed from admission to 6 months postoperatively. Surgical delay was defined as time from admission to surgery. Secondary outcomes included length of hospital stay, transfusion rates, perioperative bleeding loss, postoperative wound ooze, mortality and risk of reoperation. The use of general versus neuraxial anaesthesia was registered. Continuous outcomes were analysed using Students t test, while categorical outcomes were expressed by Odds ratios.
47 hip fracture patients (15%) were using DOACs. No difference in surgical delay (29 vs 26 h, p = 0.26) or length of hospital stay (6.6 vs 6.1 days, p = 0.34) were found between DOAC-users and non-users. DOAC-users operated with neuraxial anaesthesia had longer surgical delay compared to DOAC-users operated with general anaesthesia (35 h vs 22 h, p < 0.001). Perioperative blood loss, transfusion rate, risk of bleeding complications and mortality were similar between groups.
Hip fracture patients using DOAC did not have increased surgical delay, length of stay or risk of reported bleeding complications than patients without anticoagulation prior to surgery. The increased surgical delay found for DOAC-users operated with neuraxial anaesthesia should be interpreted with caution.
直接口服抗凝剂（DOAC）在髋部骨折患者中的围手术期后果尚未得到充分研究。本研究的主要目的是确定 DOAC 使用者与非使用者相比是否存在手术延迟。其次，我们研究了 DOAC 的使用是否会影响住院时间、死亡率、再次手术和出血并发症。
评估了 2016 年至 2017 年间在一家创伤中心接受髋部骨折手术的 314 名患者的病历。排除年龄<60 岁和使用 DOAC 以外的其他形式抗凝治疗的患者。患者从入院开始随访至术后 6 个月。手术延迟定义为从入院到手术的时间。次要结局包括住院时间、输血率、围手术期出血丢失、术后伤口渗血、死亡率和再次手术风险。记录全身麻醉与椎管内麻醉的使用情况。连续结果采用学生 t 检验分析，分类结果用比值比表示。
47 例（15%）髋部骨折患者使用 DOAC。DOAC 使用者与非使用者之间手术延迟（29 小时与 26 小时，p=0.26）或住院时间（6.6 天与 6.1 天，p=0.34）无差异。接受椎管内麻醉的 DOAC 使用者与接受全身麻醉的 DOAC 使用者相比，手术延迟时间更长（35 小时与 22 小时，p<0.001）。两组之间围手术期失血、输血率、出血并发症风险和死亡率相似。
与术前未抗凝的患者相比，使用 DOAC 的髋部骨折患者手术延迟、住院时间或报告出血并发症风险没有增加。对于接受椎管内麻醉的 DOAC 使用者，发现手术延迟增加，应谨慎解释。
