Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY.
Department of Orthopaedics, Cedars-Sinai Health System, Los Angeles, CA.
J Orthop Trauma. 2022 Apr 1;36(4):172-178. doi: 10.1097/BOT.0000000000002251.
To compare transfusion rates in patients on direct oral anticoagulants (DOACs) with nonanticoagulated patients undergoing hip fracture surgery and, secondarily, to determine whether time to surgery or complications differ between these groups.
Multicenter retrospective cohort.
Three tertiary care, academic, Level I trauma centers.
Acute, operatively treated, low-energy hip fracture patients 55 years of age and older were included. Anticoagulated patients were matched in a 1:2 ratio to "control" nonanticoagulated hip fracture patients using propensity score matching.
The primary outcome was incidence of perioperative transfusion. The secondary outcomes included time to surgery, length of stay, and 90-day complications, readmissions, reoperations, and mortality.
One hundred thirty-two patients with hip fracture admitted on DOACs were identified (107 factor Xa inhibitors, 25 dabigatran) and were matched to 262 "control" nonanticoagulated patients. There was no difference in overall transfusion rates between anticoagulation and control groups (43.2%; n = 57 DOAC vs. 39.7%; n = 104 control; P = 0.517). The median time from admission to surgery was 41.7 hours in the DOAC group and 26.0 hours in the control group (P < 0.001). There were no differences in 90-day complication, readmission, reoperation, or mortality rates between DOAC and control groups. Comparing DOAC patients undergoing surgery within 24 hours and after 24 hours, there were no differences in transfusion rates (P = 0.558) or overall complication rates (P = 0.179).
This study supports growing evidence that DOAC use should not be a determining factor in delaying surgery for patients with hip fracture who are otherwise medically optimized.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较直接口服抗凝剂（DOAC）患者与未抗凝髋关节骨折手术患者的输血率，并确定这两组患者的手术时间或并发症是否存在差异。
多中心回顾性队列研究。
三家三级保健、学术性、一级创伤中心。
纳入年龄≥ 55 岁的急性手术治疗低能量髋关节骨折患者。采用倾向评分匹配，将接受抗凝治疗的患者与“对照”非抗凝髋关节骨折患者以 1:2 的比例进行匹配。
主要结局为围手术期输血的发生率。次要结局包括手术时间、住院时间和 90 天并发症、再入院、再次手术和死亡率。
共确定了 132 例髋关节骨折服用 DOAC 的患者（107 例为因子 Xa 抑制剂，25 例为达比加群），并与 262 例“对照”非抗凝患者相匹配。抗凝组与对照组的总输血率无差异（43.2%[n=57 DOAC]与 39.7%[n=104 对照组]；P=0.517）。DOAC 组从入院到手术的中位时间为 41.7 小时，对照组为 26.0 小时（P＜0.001）。DOAC 组和对照组 90 天并发症、再入院、再次手术或死亡率无差异。比较 DOAC 患者在 24 小时内和 24 小时后手术，输血率（P=0.558）或总并发症率（P=0.179）无差异。
本研究支持越来越多的证据表明，对于其他方面已进行医学优化的髋部骨折患者，不应因使用 DOAC 而延迟手术。
治疗性 III 级。有关完整的证据水平说明，请参见作者指南。
