Abstract Number: PB1113
Meeting: ISTH 2020 Congress
Background: Peri-procedural management of oral anticoagulants (OACs) in surgical hip fracture patients requires navigating the competing risks associated with surgical delay, anesthetic risks and operative hemostasis. Guidelines recommend surgery within 48 hours among patients presenting with hip fractures; however, management of surgical timing for patients on OACs remains unclear. Individual studies report small sample sizes and heterogeneous outcomes.
Aims: To conduct a systematic review and meta-analysis to summarize the effect of pre-hospital OAC use on time to surgery and all-cause mortality among older adults with hip fracture treated surgically.
Methods: We searched MEDLINE, EMBASE and CENTRAL (from inception to 14 October 2019) to identify studies directly comparing outcomes among hip fracture patients receiving direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) prior to admission with hip fracture patients not on OACs. Random effects were used to pool all outcomes of interest (time-to-surgery and in-hospital mortality).
Results: Thirty four studies (involving 39,446 patients) were included in our systematic review. Time-to-surgery was 14.7 hours longer (95% CI 10.8 – 18.6) among hip fracture patients on OACs compared to those not on antithrombotics (Figure). Anticoagulated patients had a three-fold higher odds of having surgery beyond the recommended 48 hours from admission (odds ratio 3.0, 95% CI 2.1-4.3). In-hospital mortality was higher (odds ratio 1.4, 95% CI 1.1-1.7) among anticoagulated patients. Among studies comparing anticoagulants, we observed a trend towards longer time-to-surgery among patients taking DOACs compared to VKA (7.1 hours, 95% CI -1.1 – 15.4).
Conclusions: Patients presenting with hip fracture who were taking OACs prior to injury experience delay in time-to-surgery and higher mortality than non-anticoagulated patients. Patients on DOACs may be at risk of extended delays. Evaluating expedited surgical protocols in hip fracture patients on OACs is an urgent priority, with the potential to decrease morbidity and mortality in this group of high-risk patients.
To cite this abstract in AMA style:Xu Y, You D, Ponich B, Krzyzaniak H, Ronksley P, Skeith L, Schneider P, Carrier M. Effect of Oral Anticoagulant Use on Surgical Delay and Outcomes in Hip Fracture Patients: A Systematic Review and Meta-Analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/effect-of-oral-anticoagulant-use-on-surgical-delay-and-outcomes-in-hip-fracture-patients-a-systematic-review-and-meta-analysis/. Accessed January 28, 2022.
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