Résumé
Hip fractures remain a challenge for patients on direct oral anticoagulants. In a population-based study, we wanted to evaluate the impact of DOACS and its concentration on postoperative mortality after hip fracture surgery.
In a retrospective, monocenter study, we included all patients aged >65 yrs at a geriatric perioperative unit, admitted for hip fracture, treated with or without DOACs, and similarly managed with early surgery. Patients were divided into No-DOACs or DOACs groups. According to plasma DOAC concentrations on the day of surgery, DAOCs was divided into subgroup: <30, 30−50, 51−80 ng.mL−1. Plasma of DOACs were analysed as long as the concentrations measured were >30 ng.mL−1. The primary endpoint was mortality up to Day 30. Patient blood management and plasma assays were recorded.
From January 2022 to September 2023, 117 patients were analyzed in the DOACs group and 468 in the No-DOACs group. Patients with DOACs were most often operated on with a one-day delay (P < 0.05). Non DAOC group presented lower mortality at 30 day (P < 0.01). Up to Day 180, mortality rates were lower in the No-DOACs group with a 0.34 median hazard-risk [0.19−0.59]. Transfusion rates were similar in No-DOACs and DOACs groups (43 versus 48%, P = 0.55). Subgroups (<30, 30−50, 50–80 ng.mL−1) presented similar outcomes (transfusion, mortality).
DOACs were associated with higher mortality. A level of up to < 80 ng.mL−1 does not appear to make any difference to transfusion compared with no DOAC.
NCT06382584 (registration date: 2024−04-24, registered retrospectively.