# Clinical outcomes in elderly patients on direct oral anticoagulant drugs undergoing surgery for acute hip fracture (AHF)

## TL;DR

Elderly patients on direct oral anticoagulants who undergo surgery for hip fractures face higher mortality and complications compared to those not on these drugs.

## Contribution

This study identifies DOAC use as an independent predictor of 360-day mortality in elderly hip fracture patients.

## Key findings

- DOAC-users had significantly higher 360-day mortality compared to non-users.
- DOAC-users experienced longer time to surgery and higher transfusion rates.
- The association between DOAC use and mortality remained significant after adjusting for covariates.

## Abstract

This single-center retrospective observational study analyzed 594 elderly acute hip fracture (AHF) patients surgically treated in 2023. The primary aim was to determine if direct oral anticoagulant (DOAC) therapy in elderly AHF patients is associated with higher mortality 360 days after surgery. Secondary aims were to assess whether DOAC-users have a longer time to surgery and/or higher transfusion requirements than non-users. Numerical outcomes were analyzed using the Mann-Whitney U test, and categorical outcomes using the Chi-squared test. To analyze mortality, Kaplan-Meier survival curves and multivariate Cox regression were used.

170 AHF patients (28.6%) were treated with DOACs. DOAC-users had a higher mortality 360 days after surgery compared to non-users (35.9% vs. 16.7%, p < 0.001). This association remained significant after adjusting for covariates (HR = 1.57, p = 0.02). Further, patients using DOACs had a longer time to start of surgery (24.6 h vs. 22.6 h, p = 0.0048) and higher transfusion rates (51.2% vs. 39.4%, p = 0.009), while transfusion volumes did not differ (p = 0.091).

Surgically treated acute hip fracture patients on DOACs had higher 360-day mortality, adjusted for age, sex, comorbidity and frailty. Additionally, these patients experienced longer time to surgery and higher transfusion rates. This study provides important insights into the perioperative outcomes of elderly AHF patients using DOACs and highlights the need for further research.

Aim: This study aims to examine whether direct oral anticoagulant (DOAC) therapy, in elderly acute hip fracture (AHF) patients, is associated with higher mortality 360 days after surgery.

Findings: DOAC-users had a significantly higher 360-day mortality. DOAC use was identified as an independent predictor of mortality.

Message: The findings highlight the challenges of managing AHF patients on DOAC therapy and inspire future research to improve outcome for this vulnerable group of patients.