Evidence map›Paper›PMID 37001973›Full record

SynthesisCanadian journal of surgery. Journal canadien de chirurgie

Safety of expedited-surgery protocols in anticoagulant-treated patients with hip fracture: a systematic review and meta-analysis.

Daniel You, Yan Xu, Halli Krzyzaniak, Robert Korley, Marc Carrier, Prism Schneider

Open access · diamondAbstract readMeta-AnalysisSystematic Review

In one paragraph

Synthesis in Canadian journal of surgery. Journal canadien de chirurgie. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it

0cells of the map it votes in

12citing papers in PubMed

5.1field-weighted citation impact, top 4% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 16 citations in OpenAlex.

[Treatment of proximal femur fractures in patients on direct oral anticoagulants (DOACs) : Review of perioperative management].Unfallchirurgie (Heidelberg, Germany) · 2026
Review
Preoperative antithrombotic use is associated with delayed mobilization and plural blood transfusions following hip fracture surgery: a case-control study.European geriatric medicine · 2026
Article
When the Heart and Hip Collide: The Interplay Between Atrial Fibrillation and Neck of Femur Fractures.Journal of cardiovascular development and disease · 2026
Review
Management and optimisation in the preoperative phase for patients with a fractured hip.EFORT open reviews · 2026
Review
Perioperative Anemia and Transfusion Management in Older Adults with Osteoporotic Hip Fractures: A Narrative Review of Current Evidence and Emerging Strategies.Clinical interventions in aging · 2026
Review
Effect of an Optimized Clinical Pathway Protocol Including Fascia Iliaca Compartment Block on Delirium and Postoperative Complications in Elderly Hip Fracture Patients.Journal of clinical medicine · 2025
Article
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 · 2025
Observational
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 · 2025
Article
The management of anticoagulated fragility femoral fracture patients.Hip international : the journal of clinical and experimental research on hip pathology and therapy · 2024
Review
Coagulation Tests and Reversal Agents in Patients Treated with Oral Anticoagulants: The Challenging Scenarios of Life-Threatening Bleeding and Unplanned Invasive Procedures.Journal of clinical medicine · 2024
Review
Management of patients with proximal femur fractures under DOACs.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024
Review
Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023
Review

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 2 countries.

Daniel YouFrom the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont. (Xu, Carrier); and the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Krzyzaniak).

Yan XuFrom the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont. (Xu, Carrier); and the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Krzyzaniak).

Halli KrzyzaniakFrom the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont. (Xu, Carrier); and the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Krzyzaniak).

Robert KorleyFrom the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont. (Xu, Carrier); and the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Krzyzaniak).

Marc CarrierFrom the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont. (Xu, Carrier); and the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Krzyzaniak).

Prism SchneiderFrom the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (You, Korley, Schneider); the Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont. (Xu, Carrier); and the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Krzyzaniak) prism.schneider@gmail.com.

Alberta Bone and Joint Health Institute · CACarrier (United States) · USUniversity of Calgary · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPerioperative management of patients with hip fracture patients receiving oral anticoagulants requires navigating the risks associated with surgical delay and perioperative hemostasis. The aim of this systematic review and meta-analysis was to evaluate the effect of expedited-surgery protocols on time to surgery and perioperative outcomes in anticoagulant-treated patients with hip fracture.

methodsWe searched MEDLINE, Embase and CENTRAL from inception to May 5, 2020, to identify English-language studies reporting outcomes after expedited hip fracture surgery in patients receiving vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) before hospital admission. We performed a meta-analysis using Mantel-Haenszel weighting for dichotomous variables and inverse variance weighting for continuous variables.

resultsAmong the 4253 citations identified, 14 studies were included. In the 6 studies eligible for meta-analysis, compared to hip fracture surgery before implementation of a VKA-reversal protocol, surgery after implementation of such a protocol was associated with a significant reduction in time to surgery (mean difference 45.31 h, 95% confidence interval [CI] 15.81 h to 74.80 h). Expedited surgery (within 48 h) in patients who received DOACs preoperatively was not associated with increased surgical duration (mean difference -7.29 min, 95% CI -22.5 min to 7.95 min) or 30-day mortality (odds ratio [OR] 1.30, 95% CI 0.49 to 3.89) compared to patients who did not receive anticoagulants (control patients). However, expedited surgery in DOAC-treated patients was associated with an increased blood transfusion risk compared to control patients (OR 0.58, 95% CI 0.36 to 0.96).

conclusionImplementing a VKA-reversal protocol for patients with hip fracture is effective in decreasing time to surgery, without an increased bleeding risk. Performing hip fracture surgery within 48 hours in DOAC-treated patients is also safe, with a small increase in blood transfusion risk.

Indexed as

AnticoagulantsHip FracturesAdministration, OralBlood TransfusionHemorrhageHumansAnticoagulants

Identifiers

PMID37001973

DOI10.1503/cjs.010021

PMCPMC10069416

OpenAlexW4362467461

What OpenQuestion holds

Textmetadata

LicenceCC BY-NC-ND

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.