Wijekulasuriya Shalini, Seymour Hannah, Tarrant Seth, Balogh Zsolt J, Navarre Pierre, Hallen Jamie, Hurring Sarah, Mitchell Rebecca
Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
Department of Geriatric Medicine, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia.
Osteoporos Int. 2025 Aug 19. doi: 10.1007/s00198-025-07659-y.
Management of hip fracture patients on direct oral anticoagulants in Australia and New Zealand is unclear. Hip fracture patients on DOACs had three times higher odds of time to surgery > 36 h than patients on no antithrombotic medication. Balancing individual considerations and guidelines may shorten time to surgery.
The management of hip fracture patients taking direct oral anticoagulants (DOACs) requires balancing anticoagulation concerns and adherence to recommendations of surgery within 36 h. This study compares the management and time to surgery of hip fracture patients in Australia and New Zealand who were on DOACs, other antithrombotic medication, and no antithrombotic medication.
A sprint audit of hospitals participating in the Australian and New Zealand Hip Fracture Registry (ANZHFR) was conducted. Sprint audit data regarding DOAC use, demographics, and clinical management was collected for consecutive patients aged ≥ 50 years admitted to hospital with a hip fracture between 1 June and 30 July 2024. The primary outcome was time to surgery.
Of 1043 hip fracture patients, 192 (18%) were taking DOACs on presentation to hospital. Patients on DOACs had 3 times higher odds (OR 3.65, 95% CI 2.40-5.55), and patients on other antithrombotic medication had 1.6 times higher odds (OR 1.62, 95% CI 1.12-2.34) of time to surgery > 36 h, compared to patients on no antithrombotic medication. The median time to surgery for patients on DOACs was 39 h (IQR 24-48); for patients on no or other antithrombotic medication, time to surgery was 25 h (IQR 20-39) and 27 h (IQR 20-44), respectively. There were no differences in the proportion of patients who had perioperative blood transfusions.
Patients on DOACs are likely to experience delays to surgery compared to patients on no antithrombotic medication, beyond what patients on other antithrombotic medications may experience.
在澳大利亚和新西兰，对于服用直接口服抗凝剂的髋部骨折患者，其管理方式尚不明确。与未服用抗血栓药物的患者相比，服用直接口服抗凝剂（DOACs）的髋部骨折患者手术时间超过36小时的几率高出三倍。平衡个体因素和指南可能会缩短手术时间。
对服用直接口服抗凝剂（DOACs）的髋部骨折患者进行管理，需要在抗凝问题和在36小时内遵循手术建议之间取得平衡。本研究比较了澳大利亚和新西兰服用DOACs、其他抗血栓药物以及未服用抗血栓药物的髋部骨折患者的管理情况和手术时间。
对参与澳大利亚和新西兰髋部骨折登记处（ANZHFR）的医院进行了快速审核。收集了2024年6月1日至7月30日期间因髋部骨折入院的连续≥50岁患者关于DOAC使用、人口统计学和临床管理的快速审核数据。主要结局是手术时间。
在1043例髋部骨折患者中，192例（18%）入院时正在服用DOACs。与未服用抗血栓药物的患者相比，服用DOACs的患者手术时间超过36小时的几率高出3倍（比值比3.65，95%置信区间2.40 - 5.55），服用其他抗血栓药物的患者高出1.6倍（比值比1.62，95%置信区间1.12 - 2.34）。服用DOACs的患者手术中位时间为39小时（四分位间距24 - 48）；未服用或服用其他抗血栓药物的患者手术时间分别为25小时（四分位间距20 - 39）和27小时（四分位间距20 - 44）。围手术期输血患者比例无差异。
与未服用抗血栓药物的患者相比，服用DOACs的患者手术可能会延迟，且比服用其他抗血栓药物的患者延迟更明显。
