Revista espanola de cirugia ortopedica y traumatologia · 2026
Healthcare impact of increased use of direct oral anticoagulants in patients with hip fractures. A retrospective study.
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Sanz-Romera J, Bellido L, Miranda I, Sangüesa-Nebot M J
Аннотация
INTRODUCTION AND AIM: Hip fractures are a major cause of hospital admissions in orthopedic trauma, predominantly affecting elderly patients. The frequent use of anticoagulants in this population significantly impacts perioperative management. The aim was to analyze anticoagulant use in the general population and in patients with hip fractures, evaluating changes in prescription patterns and their clinical impact.
MATERIAL AND METHODS: A retrospective, analytical, and observational cohort study was conducted, including 435 patients who underwent surgical treatment for hip fractures in 2018 and 2023. The type of anticoagulation was recorded, and variables such as surgical delay, hospital length of stay, and mortality were analyzed and compared.
RESULTS: The use of direct oral anticoagulants (DOACs) increased significantly, with apixaban (+400%) and edoxaban (+20%), while that of acenocoumarol decreased by 33.33% (p=0.001). Surgical delay was longer in DOAC users (77±32h) than in those on acenocoumarol (55±27h) and non-anticoagulated patients (41±38h; p<0.005). Hospital stays were also longer with DOACs (8.96±4 days) vs non-anticoagulated patients (7.63±4 days; p=0.021). Worse survival rates were found in hip fracture patients anticoagulated with acenocoumarol compared with those receiving DOACs and non-anticoagulated patients.
CONCLUSION: The analysis of anticoagulant use from 2018 to 2023 revealed a significant shift in prescription patterns, both in the general population and in patients with hip fractures. DOAC use was associated with increased surgical delay and longer hospital stays in patients with proximal femur. The use of acenocoumarol is associated with an increase in mortality in patients who have undergone hip fracture surgery compared to users of DOACs.
MATERIAL AND METHODS: A retrospective, analytical, and observational cohort study was conducted, including 435 patients who underwent surgical treatment for hip fractures in 2018 and 2023. The type of anticoagulation was recorded, and variables such as surgical delay, hospital length of stay, and mortality were analyzed and compared.
RESULTS: The use of direct oral anticoagulants (DOACs) increased significantly, with apixaban (+400%) and edoxaban (+20%), while that of acenocoumarol decreased by 33.33% (p=0.001). Surgical delay was longer in DOAC users (77±32h) than in those on acenocoumarol (55±27h) and non-anticoagulated patients (41±38h; p<0.005). Hospital stays were also longer with DOACs (8.96±4 days) vs non-anticoagulated patients (7.63±4 days; p=0.021). Worse survival rates were found in hip fracture patients anticoagulated with acenocoumarol compared with those receiving DOACs and non-anticoagulated patients.
CONCLUSION: The analysis of anticoagulant use from 2018 to 2023 revealed a significant shift in prescription patterns, both in the general population and in patients with hip fractures. DOAC use was associated with increased surgical delay and longer hospital stays in patients with proximal femur. The use of acenocoumarol is associated with an increase in mortality in patients who have undergone hip fracture surgery compared to users of DOACs.