ArticleJournal of clinical orthopaedics and trauma2021
Direct oral anticoagulants (DOACs) and neck of femur fractures: Standardising the perioperative management and time to surgery.
Article in Journal of clinical orthopaedics and trauma, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 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
- Preoperative antithrombotic use is associated with delayed mobilization and plural blood transfusions following hip fracture surgery: a case-control study.European geriatric medicine · 2026Article
- A comparison of the effects of direct oral anticoagulants versus vitamin K antagonists and antiplatelet agents on the timing and outcomes of hip fracture surgery in patients older than 65 years: the ORTHO-GER-DOAC study.European geriatric medicine · 2025Observational
- The management of anticoagulated fragility femoral fracture patients.Hip international : the journal of clinical and experimental research on hip pathology and therapy · 2024Review
- First year report of the IMSS Multicenter Hip Fracture Registry.Archives of osteoporosis · 2024Observational
- 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
- 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
- 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
- Proximal femur fractures in patients taking anti-coagulants: has anything changed?EFORT open reviews · 2022Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Demographic projections for hip fragility fractures indicate a rising annual incidence by virtue of a multimorbid, ageing population with more noncommunicable diseases (NCDs). NCDs are characterised by slow progression and long duration ranging from ischaemic cardiovascular disease, cerebrovascular disease, diabetes, chronic obstructive pulmonary disease to various cancers. Management of this disease burden often involves commencing patients on oral anticoagulants to reduce the risk of thromboembolic events. The use of direct oral anticoagulants (DOACs) in clinical practice has increased due to their rapid onset of action, short half-life and predictable anticoagulant effects, without the need for routine monitoring. Safe and timely surgical intervention relies on reversal of anticoagulants. However, the lack of specific evidence-based guidelines for the perioperative management of patients on DOACs with hip fractures has proved challenging; in particular, the accessibility of DOAC-specific assays, justification of the cost-benefit ratio of targeted reversal agents and indications for neuraxial anaesthesia. This has led to potentially avoidable delays in surgical intervention. Following a literature review of the pharmacokinetic and pharmacodynamics of commonly used DOACs in our region including the role of surrogate markers, we propose a systematic, evidence-based guideline to the perioperative management of hip fractures DOACs. We believe this standardised protocol can be easily replicated between hospitals. We recommend that if patients are deemed suitable for a general anaesthesia, with satisfactory renal function, optimal surgical time should be 24 h following the last ingested dose of DOAC.
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Registered trials
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