ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2024
Use of direct-acting anticoagulants (DOACs) delays surgery and is associated with increased mortality in hip fracture patients.
Article 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 10 papers.
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Who cites it
10 citing papers in PubMed.
- Waiting time and mortality after hip fracture: findings from a large single-center cohort study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- 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
- Review
- Factors influencing the implementation of best clinical practices for hip fracture management in resource-constrained hospitals in China and co-design of quality improvement interventions: a qualitative study.The Lancet regional health. Western Pacific · 2026Article
- Blood Transfusion Risk Following Early Versus Delayed Surgery in Hip Fracture Patients on Direct Oral Anticoagulants: A Study Protocol for a Natural Experiment.Journal of clinical medicine · 2026Article
- Clinical outcomes in elderly patients on direct oral anticoagulant drugs undergoing surgery for acute hip fracture (AHF).European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Observational
- An Acta Orthopaedica educational article: Femoral neck fractures in adults with emphasis on surgical treatment.Acta orthopaedica · 2025Review
- 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
- Predictors of 1-year mortality in a clinical cohort of hip fracture patients.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Article
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Abstract
purposeTreatment with direct-acting oral anticoagulants (DOACs) is increasing among hip-fracture patients, with accompanying safety concerns regarding spinal anesthesia (SA). The aim of this study was to investigate if DOAC use is associated with increased waiting time before surgery, increased mortality, or other adverse events.
methodsRegistry data on surgically treated hip-fracture cases at a single hospital between 2015 and 2021 were analyzed. Multivariable regression analyses were performed with DOAC-status and choice of anesthesia as exposures, and waiting time, length of stay, transfusion, and mortality as outcomes.
results2885 cases were included, 467 patients (16%) were using DOACs. DOAC users were older (86.3 vs. 82.2 years, p < 0.001), had a higher Charlson Comorbidity Index (2.1 vs. 1.5, p < 0.001) and had longer median time to surgery than non-DOAC cases (36 h vs 17 h, p < 0.001). General anesthesia (GA) was used in 19.3% of DOAC patients and in 3.0% of non-DOAC patients. DOAC-patients had an increased risk of one-month mortality (Adjusted Odds Ratio (AOR) 1.6 (1.1-2.3)) and one-year mortality (AOR 1.4 (1.1-1.8)). There were no differences in risk of blood transfusion. Patients on DOAC operated under GA had a lower risk of one-year mortality (AOR 0.5 (0.3-0.9)), but a similar one-month mortality to DOAC-patients operated under SA.
conclusionDOAC users had a longer waiting time to surgery, indicating postponement of surgery due to concerns of the safety of SA. The clinical practice should be changed to allow earlier surgery for DOAC patients.
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