Delayed surgery does not reduce transfusion rates in low energy hip fractures on direct oral anticoagulants (DOACs).

OBJECTIVES To compare transfusion rates in patients on direct oral anticoagulants (DOACs) with non-anticoagulated patients undergoing hip fracture surgery and, secondarily, to determine if time to surgery or complications differ between these groups. DESIGN Multicenter retrospective cohort. SETTING Three tertiary care, academic, level I trauma centers Patients: Acute, operatively treated, low-energy hip fracture patients aged 55 and older were included. Anticoagulated patients were matched in a 1:2 ratio to "control" non-anticoagulated hip fracture patients using propensity score matching. MAIN OUTCOME MEASUREMENTS The primary outcome was incidence of perioperative transfusion. Secondary outcomes include time to surgery, length of stay, 90-day complications, re-admissions, re-operations and mortality. RESULTS 132 hip fracture patients admitted on DOACs were identified (107 factor Xa inhibitors, 25 dabigatran) and were matched to 262 "control" non-anticoagulated patients. There was no difference in overall transfusion rates between anticoagulation groups (43.2%; n=57 DOAC vs. 39.7%; n=104 control; p=0.517). 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, re-operation 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). CONCLUSION This study supports growing evidence that DOAC use should not be a determining factor in delaying surgery for hip fracture patients who are otherwise medically optimized. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.