gms | German Medical Science

Objectives: About one third of all patients with hip fractures take oral anticoagulation like aspirin or direct platelet aggregation inhibitors like Clopidogrel and Ticagrelor (APD), vitamin-K-antagonists like Warfarin (VKA) or direct oral anticoagulants like Rivaroxaban, Dabigatran and Apixaban (DOAC). The perioperative management and operative timing of these patients is a rising challenge in orthopedic trauma. Our objective was to determine the effect of oral anticoagulation on patients with hip fractures, which received endoprosthetic treatment within 24 hours after trauma.

Methods: Between 2016 and 2020 only hip fracture patients treated within 24h after admission were included in the study. A retrospective chart review of 221 patients (mean age 83+/-7 years; 161 women and 60 men) treated with hemiarthroplasty was performed. Solely patients without or with only one type of oral anticoagulation were included. There were 68 patients with antiplatelet drugs (APD), 34 with DOAC and 9 with VKA medication. All patients taking VKA received high dose Vitamin K or coagulation factors to normalize INR prior to surgery. Primary outcome measures were transfusion rate and pre- and postoperative hemoglobin (Hb) difference. Secondary outcome measures were mortality and rate of postoperative hematoma that needed operative treatment.

Results and Conclusion: Mean time to surgery was significantly longer for DOAC and VKA compared to controls (none: 14 +/-7 h; APD 12+/-6 h; DOAC 18+/- 6hh; VKA 19+/-5 h; p<0.001), but there was no difference in preoperative Hb-level between the groups. Overall 62 patients needed blood transfusions during the hospital stay with no significant difference between the groups. Patients on VKA without an intraoperative blood transfusion showed lower postoperative Hb-difference compared with controls. DOAC and APD showed no difference in postoperative Hb-difference compared to controls. No type of anticoagulation showed a significant effect on postoperative hematoma (3,2%;n=7) or hospital mortality (7,7%;n=17).

Early endoprosthetic treatment of hip fractures is safe even in patients with DOAC. Still, all patients should be preoperatively prepared for possibly intraoperative transfusion.