ReviewEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2024
Management of patients with proximal femur fractures under DOACs.
Review in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Early surgery of trochanteric femoral fractures in patients on direct oral anticoagulants (DOACs) reduces the length of stay (LOS) and the 1-year mortality rates without increasing the risk for revision surgery: a matched-pair analysis.Archives of orthopaedic and trauma surgery · 2026Article
- Retrospective study of mechanical complications after cephalomedullary nail implantation from 2019 to 2024 following per-, sub- or intertrochanteric femur fractures.Archives of orthopaedic and trauma surgery · 2026Article
- Early surgical fixation of proximal femur fractures under active direct oral anticoagulation (DOAC) therapy does not increase the postoperative blood loss. Results from a prospective cohort study with a matched-pair analysis.Archives of orthopaedic and trauma surgery · 2025Article
- Focus on the proximal femur.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
Corrections and comments
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Authors and funding
1 author.
Funding
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Abstract
purposeIn the past, preinjury direct oral anticoagulant (DOAC) intake has led to delays in time to surgery (TTS) in patients with proximal femur fractures and delays in surgery have been associated with impaired outcomes. Although healthcare institutions/federal committees have set rules for treatment within 24 h of injury, comprehensive guidelines for the perioperative management of these patients, in particular when on preinjury DOACs, are still lacking. This contribution aims to summarize the current evidence on the safe time window for surgery in patients with proximal femur fractures on preinjury DOACs and to outline therapeutic options if emergency DOAC reversal becomes necessary.
methodsNarrative review based upon selective review of the pertinent literature.
resultsFor the majority of patients with proximal femur fractures and on preinjury DOACs, early surgery appears safe as soon as medical clearance has been obtained. There may be an increase in the need for blood products but with data not yet conclusive. Work-up including assessment of remaining anticoagulant activity and potential reversal should be restricted to patients at risk for bleeding complications, in particular in the presence of renal/hepatic impairment. Methodology for rapid assessment of DOACs including quantitative/qualitative concentration levels is work in progress. In the case of bleeding, rapidly acting reversal agents are available.
conclusionPreinjury DOAC use should not routinely delay surgery in patients with proximal femur fractures.
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