A comparison of the effects of direct oral anticoagulants versus vitamin K antagonists and antiplatelet agents on the timing and outcomes of hip fracture surgery in patients older than 65 years: the ORTHO-GER-DOAC study

Aim: To assess whether preoperative DOAC activity measurement enables surgery within 48 h amongst hip fracture patients at a similar prevalence compared with patients receiving other antithrombotics and patients receiving no antithrombotics. Findings: Preoperative DOAC drug measurement significantly delayed the time to surgery, whereas DOACs were associated with greater perioperative blood loss, even amongst patients with low presurgical drug levels and regardless of the type of anaesthesia. Message: In patients with hip fracture who are receiving DOACs, a protocol for expedited surgery can be applied in which DOACs are stopped before surgery for at least 48 h for factor Xa inhibitors and according to renal function and up to 96 h after the last dose of dabigatran. In this protocol, no drug-level testing is performed.