Tarrant Seth M, Catanach Michael J, Sarrami Mahsa, Clapham Matthew, Attia John, Balogh Zsolt J
John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia.
University of Newcastle, Callaghan NSW 2308, Australia.
J Clin Med. 2020 Jul 12;9(7):2200. doi: 10.3390/jcm9072200.
Timely surgical intervention in hip fracture has been linked to improved outcomes. Direct Oral Anticoagulants (DOACs) are an emerging class of anticoagulants without evidence-based guidelines on surgical timing. This study aims to investigate how DOACs affect surgical timing and hence perioperative outcomes. A retrospective database/registry review was conducted for geriatric hip fracture patients aged 65 and over between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included serious adverse events (SAE), transfusion and postoperative day (POD) 1 haemoglobin (Hb) levels. From a cohort of 3264 patients, 112 admitted subjects were taking DOACs; the annual proportion on DOACs increased over time. Mean time to surgery from last dose (T) was 2.2 (±1.0 SD) days. The primary outcome, 30-day mortality, occurred in 16 (14%) patients with secondary outcomes of SAEs in 25 (22%) patients and transfusion in 30 (27%) patients. T (days) did not significantly affect 30-day mortality (odds ratio (OR): 1.37, 95% confidence interval (CI): 0.80-2.33; = 0.248), SAE (hazard ratio (HR): 1.03, 95% CI: 0.70-1.52; = 0.885), transfusion (OR: 0.72 95% CI: 0.45 to 1.16; = 0.177) or POD 1 Hb (OR: 1.99, 95% CI: -0.59 to 4.57; = 0.129). Timing of surgery does not influence common surgical outcomes such as 30-day mortality, SAE, transfusion, and POD1 Hb in patients taking DOACs on admission.
髋部骨折的及时手术干预与改善预后相关。直接口服抗凝剂（DOACs）是一类新兴的抗凝剂，目前尚无关于手术时机的循证指南。本研究旨在调查DOACs如何影响手术时机，进而影响围手术期结局。对2011年至2018年间年龄在65岁及以上的老年髋部骨折患者进行了回顾性数据库/登记研究。主要结局为30天死亡率。次要结局包括严重不良事件（SAE）、输血情况以及术后第1天的血红蛋白（Hb）水平。在3264例患者队列中，有112例入院患者正在服用DOACs；服用DOACs的年度比例随时间增加。从最后一剂药物到手术的平均时间（T）为2.2（±1.0标准差）天。主要结局30天死亡率发生在16例（14%）患者中，次要结局SAEs发生在25例（22%）患者中，输血发生在30例（27%）患者中。T（天）对30天死亡率（优势比（OR）：1.37，95%置信区间（CI）：0.80 - 2.33；P = 0.248）、SAE（风险比（HR）：1.03，95%CI：0.70 - 1.52；P = 0.885）、输血（OR：0.72，95%CI：0.45至1.16；P = 0.177）或术后第1天Hb（OR：1.99，95%CI： - 0.59至4.57；P = 0.129）均无显著影响。入院时服用DOACs的患者，手术时机并不影响常见的手术结局，如30天死亡率、SAE、输血及术后第1天Hb水平。
