# Effects of Antiplatelet and Anticoagulant Therapy on Emergency Surgical Outcomes in Orthopedic Trauma Patients With Cardiac Comorbidities

## TL;DR

This study examines how antiplatelet and anticoagulant medications affect surgical outcomes in elderly trauma patients with heart conditions.

## Contribution

The study identifies specific risk factors and outcomes for trauma patients on antithrombotic therapy, emphasizing the need for multidisciplinary protocols.

## Key findings

- Patients on dual antiplatelet therapy had higher blood loss and mortality compared to aspirin-only users.
- Surgical delay over 48 hours and age over 70 years were strong predictors of adverse outcomes.
- Direct oral anticoagulants caused the longest surgical delays and increased complication risks.

## Abstract

Background: Emergency orthopedic trauma surgery in patients with cardiac comorbidities presents a major clinical challenge due to the widespread use of antiplatelet and anticoagulant therapy.

Objective: To evaluate the impact of antiplatelet and anticoagulant therapy on perioperative bleeding, surgical timing, postoperative complications, and mortality in orthopedic trauma patients with cardiac comorbidities.

Methods: This retrospective cross-sectional study was conducted at Jinnah Hospital, Lahore, from June 2024 to June 2025. It included 246 patients with cardiac comorbidities who underwent emergency orthopedic trauma surgery. Emergency surgery was defined as operative fixation required within 72 hours of injury based on pain severity, fracture instability, neurovascular risk, or potential displacement. Data were collected on demographics, comorbidities, type of antithrombotic therapy, fracture patterns, surgical timing, intraoperative blood loss, transfusion requirements, postoperative complications, length of stay, and in-hospital mortality.

Results: The mean age of patients was 64.2±11.8 years, with 60.6% being male. Hip fractures were the most common injury (65.8%). Antiplatelet therapy was used in 55.7% of patients, anticoagulants in 31.7%, and combined therapy in 12.6%. Patients on dual antiplatelet therapy and anticoagulants had significantly greater blood loss (742±235 ml and 689±228 ml, respectively) and higher transfusion requirements compared with aspirin-only patients. Surgical delay was longest in patients on direct oral anticoagulants (56.2±14.9 hours). Postoperative complications included wound hematoma (13.8%), infection (7.7%), thromboembolic events (6.9%), and reoperation (4.5%). Overall mortality was 8.5%, highest among patients on dual antiplatelet therapy (11.7%). Logistic regression identified dual antiplatelet therapy (OR 2.4, 95% CI 1.2-4.8), anticoagulant therapy (OR 1.9, 95% CI 1.1-3.6), surgical delay >48 hours (OR 2.8, 95% CI 1.5-5.1), and age >70 years (OR 2.2, 95% CI 1.1-4.3) as independent predictors of adverse outcomes.

Conclusion: Antiplatelet and anticoagulant therapy significantly influence emergency surgical outcomes in orthopedic trauma patients with cardiac comorbidities. These findings support the need for standardized multidisciplinary perioperative protocols including early cardiology input, structured antithrombotic management pathways, and expedited surgical planning to optimize outcomes in this high-risk population.