Abstract Number: PB2465
Meeting: ISTH 2020 Congress
Background: In case of high risk of bleeding surgery, such as hip fracture, guidelines recommend waiting at least 48 hours after stopping direct Xa inhibitors and up to 96 hours for dabigatran, without drug testing.
Aims: To assess
1) whether direct oral anticoagulants (DOACs) measurement allows surgery within 48 hours when compared with vitamin K antagonists (VKA) or antiplatelet agents or no antithrombotic drug in hip fracture;
2) peri-operative total blood loss and major bleeding associated with DOACS.
Methods: Hip fracture subjects above 75 admitted to the Orthogeriatric Unit, S.Orsola Malpighi University Hospital, and to Orthopaedic Dpt of I.R.C.C.S. “ Casa Sollievo della Sofferenza” , S. Giovanni Rotondo, Italy from 2015 to 2018 were retrospectively evaluated. Antithrombotic agents were stopped at admission. Patients on VKA received vitamin K to obtain an INR < 1.5. DOACS daily testing was conducted and surgery was performed only with near or below trough levels. Hours from admission to surgery, total blood loss and major bleeding during hospitalization were recorded.
Results: Among 256 patients (M/F: 29/120; mean age: 86;range: 75-100), 102 were on antiplatelet agents, 33 on VKA, 35 on DOACS. DOACs were associated with a statistically significant longer mean time to surgery (83.5 h) than VKA (59 h) or antiplatelet agents (45 h) or no antithrombotic drug (37 h) (p=0.001). All patients underwent neuraxial anesthesia. DOACS were associated with higher mean total blood loss (1532 ml) when compared with VKA (1343 ml) or antiplatelet agents (1287 ml) or no antithrombotic drug (1105 ml) (p=0.007). Major bleedings were observed in 13 patients (4.7%) with more bleeding (5/32 -15.6%) with DOACs when compared to all the other groups (8/224 3.5%).
Conclusions: DOAC testing can delay hip fracture surgery while DOACs are associated with significantly higher total blood loss even in subjects with pre-surgical DOAC low levels.
To cite this abstract in AMA style:Cosmi B, Martini E, Sandri S, Lunardelli ML, Gorgoglione FL, De Laurenzo A, Grandone E. Direct Oral Anticoagulants in Comparison with Vitamin K Antagonists and Antiplatelet Agents on Timing and Outcomes in Hip Fracture Surgery Patients Older than 75: The ORTHO-GER-DOAC Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/direct-oral-anticoagulants-in-comparison-with-vitamin-k-antagonists-and-antiplatelet-agents-on-timing-and-outcomes-in-hip-fracture-surgery-patients-older-than-75-the-ortho-ger-doac-study/. Accessed November 30, 2023.
« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/direct-oral-anticoagulants-in-comparison-with-vitamin-k-antagonists-and-antiplatelet-agents-on-timing-and-outcomes-in-hip-fracture-surgery-patients-older-than-75-the-ortho-ger-doac-study/