ArticleDrugs & aging2019
Serum Concentrations and Elimination Rates of Direct-Acting Oral Anticoagulants (DOACs) in Older Hip Fracture Patients Hospitalized for Surgery: A Pilot Study.
Article in Drugs & aging, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 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
- Frailty as a Marker for the Plasma Concentrations of Direct Oral Anticoagulants in Older Patients: Results of an Exploratory Study.Drugs & aging · 2023Trial
- [Treatment of proximal femur fractures in patients on direct oral anticoagulants (DOACs) : Review of perioperative management].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- Anticoagulation Pauses and Anesthetic Options: A Case for Multidisciplinary Harmonization.Cureus · 2026Article
- Comparison of clinical outcomes of enoxaparin and aspirin for postoperative venous thromboembolism prophylaxis in hip fractures.Acta orthopaedica et traumatologica turcica · 2026Article
- Serum Concentration of Apixaban in Relation to Renal Function in Older Hospitalized Patients.Drugs & aging · 2025Observational
- Preoperative anticoagulation and its impact on surgical timing and postoperative outcomes in hip fracture surgery: a retrospective study at an Orthogeriatrics Clinical Care Center in Colombia.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- DOACs levels in patients with hip fracture: is there a relation with renal function and time from last drug intake?Internal and emergency medicine · 2024Article
- Management of patients with proximal femur fractures under DOACs.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Review
- Perioperative Management of Traditional and Direct Oral Anticoagulants in Hip Fracture Patients.Orthopedic reviews · 2024Article
- Preoperative Drug Monitoring in Management of Patients with Hip Fracture on Treatment with Direct Oral Anticoagulants.Clinical interventions in aging · 2024Article
- Review of perioperative outcomes and management of hip fracture patients on direct oral anticoagulants.EFORT open reviews · 2023Review
- Letter to editor concerning the article "Do anticoagulants impact the "in-house mortality" after surgical treatment of proximal femoral fractures-a multivariate analysis" (Fenwick A et al. International Orthopedics. doi: 10.1007/s00264-022-05503-0).International orthopaedics · 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
- Early Surgical Care of Anticoagulated Hip Fracture Patients Is Feasible-A Retrospective Chart Review of Hip Fracture Patients Treated with Hip Arthroplasty within 24 Hours.Journal of clinical medicine · 2022Article
- Pharmacokinetics of Direct Oral Anticoagulants in Emergency Situations: Results of the Prospective Observational RADOA-Registry.Thrombosis and haemostasis · 2022Observational
- Recent advances in the management of transient ischemic attacks.Faculty reviews · 2022Review
- Management of ongoing direct anticoagulant treatment in patients with hip fracture.Scientific reports · 2021Observational
- Direct Oral Anticoagulants and Timing of Hip Fracture Surgery.Journal of clinical medicine · 2020Article
- Early Surgical Fixation for Hip Fractures in Patients Taking Direct Oral Anticoagulation: A Retrospective Cohort Study.Geriatric orthopaedic surgery & rehabilitation · 2020Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUse of direct-acting oral anticoagulants (DOACs) is increasing, but knowledge about pharmacokinetics and safety in frail patients is lacking.
objectiveThe aim was to determine serum concentrations and elimination rates of DOACs in older hip fracture patients hospitalized for surgery.
methodsThe study included patients ≥ 65 years of age hospitalized for acute hip fracture surgery over a period of 6 months. Use of antithrombotic drugs was registered and serum samples collected for analysis of DOACs (apixaban, dabigatran and rivaroxaban) at admission and surgery. Measured concentrations were assessed in relation to reference (therapeutic) ranges of the respective drugs and applied for half-life calculations. Furthermore, waiting time for surgery was compared between DOAC and warfarin users.
resultsOf 167 patients included (median age 84 years), 11 and 14 used DOACs and warfarin, respectively. Seven of the DOAC-treated patients had concentrations above the upper reference range (> 300 nM) at admission, and concentrations were still in the reference range for five of these at surgery. Elimination half-lives could be estimated in eight patients and ranged between 14.6 and 59.7 h (median 21.6). The observed waiting time for surgery was longer for patients using DOACs than warfarin (median 44 vs. 25 h).
conclusionThis pilot study indicates that older patients prone to hip fracture are at risk of being exposed to therapeutic serum concentrations of DOACs during surgery due to reduced drug elimination rates. The observation that almost 50% of the patients had therapeutic concentrations at surgery should be investigated further regarding safety of DOAC use in this frail elderly population.
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