Main Article Content
hip fracture, peri-operative care, complications, anticoagulation
Introduction: Rapid surgical management of hip fracture patients is critical to reduce morbidity and mortality. These patients may be anti-coagulated and the new direct oral anticoagulants (DOAC) may introduce delays to treatment. Our purpose was to examine the impact of these DOAC on time to surgical management for hip fracture patients.
Methods: A prospective audit of 55 consecutive operative hip fracture patients examined time from diagnosis to surgery. Indications for anticoagulation were recorded.
Results: Time to surgery for the DOAC group was 66±16 hours, versus 38±21 and 25±19 hours for warfarin and control groups, respectively (P<0.05). Anticoagulation was for atrial fibrillation in 93%.
Conclusion: Patients on DOAC faced significant delays to surgery. Given that both DOAC use and incidence of hip fracture are expected to rise, this presents a barrier to optimized care in this vulnerable group.
2. Moran CG, Wenn RT, Sikand, M, et al. Early Mortality After Hip Fracture: Is Delay Before Surgery Important? Journal of Bone and Joint Surgery American. 2005;87-A(3):483-9.
3. Eardley WGP, Macleod KE, Freeman H, et al. "Tiers of Delay": Warfarin, Hip Fractures, and Target-Driven Care. Geriatric Orthopaedic Surgery & Rehabilitation. 2014;5(3):103-8.
4. Zuckerman JD, Skovron ML, Koval KJ. Postoperative Complications and Mortality Associated with Operative Delay in Older Patients Who Have a Fracture of the Hip. Journal of Bone and Joint Surgery American. 1995;77-A(10):1551-6.
5. Al-Ani AN, Samuelsson RN, Tidermark J, et al. Early Operation on Patients with a Hip Fracture Improved the Ability to Return to Independent Living. Journal of Bone and Joint Surgery American. 2008;90-A(7):1436-42.
6. Hip Fracture Repair: Canadian Institue for Health Information; 2016 [cited 2017 November 13]. Available from: http://waittimes.cihi.ca/All/fracture.
7. Spyropoulos AC, Al-Badri A, Sherwood MW, et al. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost. 2016;14:875-85.
8. Macle L, et al. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. Candian Journal of Cardiology. 2016;32(10):1170-85.
9. Massicotte A. A practice tool for the new oral anticoagulants. Canadian Pharmacists Journal. 2013;147(1):25-32.
10. Xarelto Product Monograph. Mississauga, ON: Bayer Inc; 2016.
11. Pradaxa Product Monograph. Burlington, ON,: Boehringer Ingelheim Canada; 2016.
12. Perioperative Anticoagulant Management Algorithm. Thrombosis Canada; 2017.
13. NOACS/DOACS Peri-Operative Management. Thrombosis Canada; 2017.
14. Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood. 2012;120(15):2954-62.
15. Apixaban Product Monograph. Kirkland, QC: Pfizer Canada Inc; 2015.
16. Tran T, Delluc A, de Wit C, et al. The impact of oral anticoagulation on time to surgery in patients hospitalized with hip fracture. Thrombosis Research. 2015;136:962-5.
17. Cohn MR, Levack AE, Trivedi NN, et al. The Hip Fracture Patient on Warfarin: Evaluating Blood Loss and Time to Surgery. J Orthop Trauma. 2017;31(8):407-13.
18. Lawrence JE, Fountain DM, Cundall-Curry DJ, et al. Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture? Clin Orthop Relat Res. 2016;475:273-9.