BackgroundIn patients with hip fracture on direct oral anti-coagulants (DOACs), timely surgery is important in optimising outcomes but the safety of early surgery is unclear. This study aims to evaluate the timing of surgery on peri- and post-operative outcomes in patients with hip fracture on DOAC therapy.MethodsSingle-centre, retrospective, population-based cohort study of patients on DOAC therapy compared to standard care with low-molecular-weight heparin (LMWH) undergoing surgery for hip fracture. Data obtained: patient demographics, fracture classification, American Society of Anaesthesiologists (ASA) classification, time to surgery, procedure performed, type of DOAC, timing of last DOAC dose, use of reversal agents or pro-coagulants and length of stay. Outcomes assessed: pre- and post-operative haemoglobin levels, incidence of blood transfusion, major haemorrhage, venous thromboembolism (VTE) and death within 30 days of surgery.ResultsA total of 755 patients were included. Compared to standard treatment, DOAC use was associated with a similar change in pre- and post-operative haemoglobin levels (P = .90), risk of blood transfusion (RR: 1.04, 95% CI: .70–1.54, P = .84), haemorrhage (RR: 1.51, 95% CI: .53-4.28, P = .44), VTE (RR: .92, 95% CI: .12–7.20, P = .94) and mortality (RR: 1.85, 95% CI: .89–3.84, P = .10), all of which were independent of the timing of surgery.ConclusionThis study builds on growing evidence that surgery for hip fracture in patients on DOAC therapy is not associated with an excessive risk of haemorrhage, irrespective of the timing of surgery. Timely surgical fixation of the hip fracture in this population is indicated in the absence of other risk factors for haemorrhage.

中文翻译：

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直接口服抗凝剂患者髋部骨折手术时机：基于人群的队列研究

背景在使用直接口服抗凝剂 (DOAC) 的髋部骨折患者中，及时手术对于优化预后很重要，但早期手术的安全性尚不清楚。本研究旨在评估接受 DOAC 治疗的髋部骨折患者的手术时机对围手术期和术后结局的影响。 - 体重肝素 (LMWH) 接受髋部骨折手术。获得的数据：患者人口统计资料、骨折分类、美国麻醉医师协会 (ASA) 分类、手术时间、所执行的程序、DOAC 类型、最后一次 DOAC 剂量的时间、逆转剂或促凝剂的使用以及住院时间。评估结果：术前和术后血红蛋白水平，术后30天内输血、大出血、静脉血栓栓塞（VTE）和死亡的发生率。结果共纳入755例患者。与标准治疗相比，DOAC 的使用与术前和术后血红蛋白水平的类似变化相关（P = .90)、输血风险 (RR: 1.04, 95% CI: .70–1.54, P = .84)、出血 (RR: 1.51, 95% CI: .53-4.28, P = .44) , VTE (RR: .92, 95% CI: .12–7.20, P = .94) 和死亡率 (RR: 1.85, 95% CI: .89–3.84, P = .10)，所有这些都独立于手术时机。结论本研究基于越来越多的证据表明，无论手术时机如何，DOAC 治疗患者的髋部骨折手术与过度出血风险无关。在没有其他出血危险因素的情况下，需要及时手术固定该人群的髋部骨折。