Evidence map›Paper›PMID 40775083›Full record

SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025

Effects of pre-operative continuing oral anticoagulants or antiplatelets on health outcomes among older patients with hip fracture: a systematic review and meta-analysis.

Ning Tang, Jing Zhang, Xinyan Liu, Dongchen Yao, Xinyi Zhang, Pengpeng Ye, Tingzhuo Liu, Jinyu Liang, Wang Yang, Elizabeth Armstrong and 6 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
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

3 citing papers in PubMed.

  1. Article
  2. Article
  3. 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

16 authors.

Ning TangSchool of Public Health, Harbin Medical University, Harbin, China.
Jing ZhangSchool of Public Health, Harbin Medical University, Harbin, China.
Xinyan LiuSchool of Public Health, Harbin Medical University, Harbin, China.
Dongchen YaoDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Xinyi ZhangSchool of Public Health, Harbin Medical University, Harbin, China.
Pengpeng YeNational Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Tingzhuo LiuSchool of Public Health, Harbin Medical University, Harbin, China.
Jinyu LiangSchool of Public Health, Harbin Medical University, Harbin, China.
Wang YangDepartment of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Elizabeth ArmstrongSchool of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
Paul MitchellSynthesis Medical NZ Limited, Dunedin, New Zealand.
Rebecca IversSchool of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
Ronald Man Yeung WongDepartment of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
Yongchen WangDepartment of General Practice, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Minghui YangDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China. doctyang0125@126.com.
Maoyi TianSchool of Public Health, Harbin Medical University, Harbin, China. maoyi.tian@hrbmu.edu.cn.ORCID http://orcid.org/0000-0002-5660-8571

Funding

Beijing Hospitals Authority clinical medicine development of special funding support ZLRK202310Capital's Funds for Health Improvement and Research 2018-1-2071Capital's Funds for Health Improvement and Research 2022-1-2071Harbin Medical University Leading Talent Grant 31021220002
6 · The paper itself

Abstract

Continuing antiplatelets during hip fracture surgery may be safe for older adults, while early surgery after discontinuation reduces hospital stay without adverse outcomes. PURPOSE: The safety of continuing antiplatelets or direct oral anticoagulants (DOACs) before surgery in older patients with hip fractures remains uncertain. The feasibility of timely surgery after discontinuation also warrants further investigation.

methodsWe included studies of hip fracture patients aged ≥ 65 years taking antiplatelets or DOACs, comparing continuation versus discontinuation, or early versus delayed surgery. MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched to November 2024. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were conducted using a random-effects model to pool effect estimates. This study was registered with PROSPERO (CRD42022378334).

resultsThirteen observational studies from nine countries involving 885 patients were included. There were no significant differences in transfusion rates in patients who continued the medication (Odds Ratio [OR] = 0.87; 95% Confidence Interval [CI]: 0.37 to 2.03). Surgery within 48 h of antiplatelet discontinuation was associated with shorter hospital stay (mean difference = - 5.71 days; 95% CI: - 8.36 to - 3.06) compared to those with delayed surgery, with no increase in transfusion (OR = 0.75; 95% CI: 0.04 to 13.73) and in-hospital mortality (OR = 0.49; 95% CI: 0.02 to 13.52). For DOAC users, no significant differences were observed in transfusion (OR = 1.09; 95% CI: 0.56 to 2.09) and 30-day mortality (OR = 1.53; 95% CI: 0.45 to 5.19) for early versus delayed surgery.

conclusionsSurgery without discontinuing antiplatelets may be safe. Early surgery after discontinuing antiplatelets could reduce hospital stays without adverse outcomes. Randomized trials are needed to confirm these findings.

Indexed as

AnticoagulantsHip FracturesOsteoporotic FracturesPlatelet Aggregation InhibitorsAdministration, OralAgedBlood TransfusionHumansLength of StayObservational Studies as TopicPreoperative CareTime-to-TreatmentAnticoagulantsPlatelet Aggregation InhibitorsAntiplatelet therapyDirect oral anticoagulantsHip fractureOlder adults

Identifiers

PMID40775083

What OpenQuestion holds

Textmetadata
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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.