Dipartimento Medicina sperimentale e clinica, Università di Firenze, Firenze, Italy.
Medicina Interna e Post-Chirurgica, AOU Careggi, Firenze, Italy.
Clin Interv Aging. 2024 Apr 29;19:655-664. doi: 10.2147/CIA.S444902. eCollection 2024.
Aim of the present study was to evaluate whether monitoring direct oral anticoagulant (DOAC) levels may improve management of anticoagulated patients who need surgery for hip fracture.
A total of 147 out of 2231 (7.7%) patients with hip fracture admitted to a tertiary teaching hospital were on DOACs (group A), whereas 206 patients matched for age, sex, and type of fracture not on anticoagulant or P2Y12 platelet inhibitors were considered as control group (group B). Patients on DOACs were divided into two subgroups: A1 in which intervention was scheduled in relation to the last drug intake according to current guidelines, and A2 included patients in whom time of surgery (TTS) was defined according to DOAC levels. Neuraxial anesthesia was considered with DOAC levels <30 ng/mL, general anesthesia for levels in the range 30-50 ng/mL.
TTS was significantly lower in controls than in DOAC patients: surgery within 48 hours was performed in 80.6% of group B versus 51% in group A (<0.0001). In A2, 41 patients underwent surgery within 48 hours (56%) in comparison to 32 A1 patients (45.1%; =0.03). TTS and length of hospitalization were on average 1 day lower in patients with assay of DOAC levels. Finally, 35/39 (89%) patients with DOAC levels <50 ng/mL had surgery within 48 hours (26 under neuraxial anesthesia, without any neurological complication, and 13 in general anesthesia).
DOAC assay in patients with hip fracture may be useful for correct definition of time to surgery, particularly in patients who are candidates for neuraxial anesthesia. Two-thirds of patients with DOAC levels <50 ng/mL at 48 hours from last drug intake underwent uneventful neuraxial anesthesia, saving at least 24 hours in comparison to guidelines.
本研究旨在评估监测直接口服抗凝剂（DOAC）水平是否可以改善需要接受髋关节骨折手术的抗凝患者的管理。
共有 2231 例髋关节骨折患者中，147 例（7.7%）正在服用 DOAC（A 组），206 例年龄、性别和骨折类型匹配且未服用抗凝药物或 P2Y12 血小板抑制剂的患者作为对照组（B 组）。A 组患者根据现行指南，根据最后一次服药时间进行干预，分为 A1 亚组；B 组根据 DOAC 水平确定手术时间（TTS），分为 A2 亚组。当 DOAC 水平<30ng/mL 时考虑使用椎管内麻醉，30-50ng/mL 时考虑使用全身麻醉。
对照组 TTS 明显低于 DOAC 组：B 组 80.6%的患者在 48 小时内进行手术，而 A 组仅 51%（<0.0001）。A2 组中，41 例患者在 48 小时内接受手术（56%），而 A1 组中仅 32 例（45.1%）（=0.03）。测定 DOAC 水平后，患者的 TTS 和住院时间平均缩短 1 天。最后，39 例 DOAC 水平<50ng/mL 的患者中有 35 例（89%）在 48 小时内进行手术（26 例接受椎管内麻醉，无任何神经并发症，13 例接受全身麻醉）。
髋关节骨折患者测定 DOAC 可能有助于正确确定手术时间，尤其是对于拟行椎管内麻醉的患者。75%的患者在最后一次服药后 48 小时内，DOAC 水平<50ng/mL 时可接受安全的椎管内麻醉，与指南相比至少节省 24 小时。
