Treatment and outcome after hip fracture for patients on oral anticoagulation.

Abstract

An increasing number of patients with hip fracture are taking oral anticoagulation medication including direct oral anticoagulants (DOAC). The management of these patients regarding the timing of surgery and occurrence of complications remains contentious. The aim of this study was to compare treatment and outcomes for hip fracture patients taking anticoagulation. Data from a consecutive series of 3,707 hip fracture patients admitted to a single centre was collected over a seven-year period. The proportion of patients taking warfarin fell slightly over the study period (6.1 % to 4.7 %) whilst the proportion taking DOAC increased greatly (1.4 % to 11.4 %). Patients on oral anticoagulation were slight older (mean age 83 years for warfarin, 85 years for DOAC versus 80 years for those not on anticoagulation), more likely to have atrial fibrillation, less likely to take anti-platelet medication and less likely to have spinal anaesthesia. Patients taking oral anticoagulant had an increased delay to theatre (mean hours admission to theatre 37.9 for warfarin, 39.5 for DOAC, 31.1 for no anticoagulation). There was no difference in the number of patients transfused, wound complications, post-operative haemoglobin or 30 -day mortality between groups. Current policies on the timing of surgery and anticoagulation are safe.