Observational studyBMJ open2018
Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre.
Observational study in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 2 syntheses or guidelines pooled it, 75 citations in OpenAlex.
- Synthesis of the evidence on the impact of pre-operative direct oral anticoagulants on patient health outcomes after hip fracture surgery: rapid systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Pooled it
- Safety of expedited-surgery protocols in anticoagulant-treated patients with hip fracture: a systematic review and meta-analysis.Canadian journal of surgery. Journal canadien de chirurgiePooled it
- Direct oral anticoagulant plasma concentrations according to the time elapsed since the last dose and to renal function: a retrospective study in geriatric patients with hip fractures.European journal of anaesthesiology and intensive care · 2026Article
- Does ongoing antithrombotic therapy increase the risk of revision after trochanteric fracture fixation? A retrospective cohort study with competing risk analyses.Archives of orthopaedic and trauma surgery · 2025Article
- The impact of direct oral anticoagulants on hip fracture care in Australia and New Zealand: a prospective patient sprint audit.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Review
- Impact of anticoagulation therapy on surgical timing, hospital stay, and postoperative outcomes in proximal femur fracture patients.Acta orthopaedica et traumatologica turcica · 2025Article
- Management of hip fracture patients on direct oral anticoagulants: a survey of orthopaedic trauma surgeons, systematic review, and meta-analysis.OTA international : the open access journal of orthopaedic trauma · 2025Article
- The management of anticoagulated fragility femoral fracture patients.Hip international : the journal of clinical and experimental research on hip pathology and therapy · 2024Review
- Key Considerations for Frail Patients Undergoing Hip Fracture Surgery.Clinics and practice · 2024Review
- Early Hip Fracture Surgery in Patients Taking Direct Oral Anticoagulants Improves Outcome.Journal of clinical medicine · 2024Article
- Pre-Operative Direct Oral Anticoagulant Level Measurement Reduces Time to Surgery in Hip Fracture Patients.Geriatric orthopaedic surgery & rehabilitation · 2024Article
- Preoperative Drug Monitoring in Management of Patients with Hip Fracture on Treatment with Direct Oral Anticoagulants.Clinical interventions in aging · 2024Article
- Expedited surgery does not increase transfusion rates for patients with geriatric hip fracture taking factor Xa inhibitors.OTA international : the open access journal of orthopaedic trauma · 2023Article
- Propensity matched analysis examining the effect of passive reversal of direct oral anticoagulants on blood loss and the need for transfusions among traumatic geriatric hip fractures.European journal of medical research · 2023Article
- Review of perioperative outcomes and management of hip fracture patients on direct oral anticoagulants.EFORT open reviews · 2023Review
- The Effect of Pre-operative use of Antiplatelets and Anticoagulants on Time to Surgery in Hip Fracture Patients.Malaysian orthopaedic journal · 2023Article
- Role of DOAC plasma concentration on perioperative blood loss and transfusion requirements in patients with hip fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- Assessing operative delay and complications in hip fracture patients on anticoagulants and antiplatelets.SAGE open medicine · 2023Article
- SHock-INduced Endotheliopathy (SHINE): A mechanistic justification for viscoelastography-guided resuscitation of traumatic and non-traumatic shock.Frontiers in physiology · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether not waiting for the elimination of direct oral anticoagulants (DOACs) has an effect on the amount of perioperative bleeding in patients who undergo operative treatment of a hip fracture.
designObservation, retrospective case-control study.
settingA single UK major trauma centre.
participantsPatients who sustained a hip fracture were identified using the National Hip Fracture Database (NHFD). All those found to be taking a DOAC at the time of fracture were identified (n=63). A matched group not taking a DOAC was also identified from the NHFD (n=62). MAIN OUTCOME: Perioperative drop in haemoglobin concentration.
resultsThere was no relationship between admission to operation interval and perioperative change in haemoglobin concentration in patients taking DOACs (regression coefficient=-0.06 g/L/hour; 95% CI -0.32-0.20; p=0.64). No relationship was found between the time from admission to operation interval and the probability of transfusion (OR=0.94; 95% CI 0.85 to 1.90; p=0.16) or reoperation (OR=1.04; 95% CI 0.93 to 1.16; p=0.49). One mortality was recorded in the DOAC group within 30 days of admission, and this compared with five in the matched group of patients (p=0.2).
conclusionsDelaying surgery in patients who sustain a hip fracture who are taking a DOAC drug has not been shown to reduce perioperative bleeding or affect their mortality in this study.
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