ArticleArchives of orthopaedic and trauma surgery2025
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.
Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- [Perioperative management of trochanteric femoral fractures : Fasting, fluid therapy and multimodal pain management as underappreciated factors].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- 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
- 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 · 2026Review
- Does ongoing antithrombotic therapy increase the risk of revision after trochanteric fracture fixation? A retrospective cohort study with competing risk analyses.Archives of orthopaedic and trauma surgery · 2025Article
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8 authors.
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Abstract
introductionThis study aims to investigate whether early surgery in patients under active DOAC (direct oral anticoagulation) therapy with trochanteric, proximal femur fractures leads to higher postoperative blood loss. MATERIAL AND
methodsA prospective cohort study on DOAC patients with trochanteric, proximal femur fractures undergoing early surgery (≤ 24 h) was conducted. Propensity score matching with a retrospective control group of DOAC patients with trochanteric, proximal femur fractures undergoing delayed surgery (> 24 h) was performed for comparison. Key outcome measurements included peri- and postoperative blood loss, transfusion rates, time to surgery and hospital length of stay (LOS).
resultsNo differences in the median blood loss in patients undergoing early surgery vs. delayed surgery on postoperative day 1 (1078.35 ml (IQR 745.86) vs. 1120.79 ml (IQR 928.50); p = 0.824) or postoperative day 3 (1592.39 ml (IQR 1304.91) vs. 1339.73 ml (IQR 735.57); p = 0.165) was seen. No differences in the rate of blood transfusion (72.5% vs. 68.1%; p = 0.576) or the number of transfused red blood cells (RBCs) (2 units (IQR 2) vs. 2 units (IQR 3); p = 0.567) were detected. A significantly longer median time to surgery, and a significantly longer LOS was seen in the delayed surgery group (p < 0.001). No difference in the rates of perioperative complications was detected between both groups.
conclusionEarly surgery of trochanteric, proximal femur fractures within 24 h under active DOAC therapy does not increase postoperative blood loss or the need for postoperative blood transfusions but leads to a significantly shorter length of stay. LEVEL OF EVIDENCE: IIb.
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