Abstract
Background of study
There has been an exponential increase in the use of direct thrombin (DT) and factor Xa inhibitors (FXI) in patients with cardiovascular problems. Premature cessation of DT/FXI in patients with cardiac conditions can increase the risk of coronary events. Our aim was to ascertain whether it is necessary to stop DT and FXI preoperatively to avoid postoperative complications following hip fracture surgery.
Materials and Methods
Prospective data was collected from 189 patients with ongoing DT/FXI therapy and patients not on DT/FXI who underwent hip fracture surgery. Statistical comparison on pre- and postoperative haemoglobin (Hb), ASA grades, comorbidities, operative times, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rates between the two groups was undertaken.
Results
There were 91 patients in the DT/FXI group (DTX) and 88 in the non-DTX group (NDTX). Mean age was 81.9 years. There was no difference in ASA grade, number of comorbidities (except cardiac comorbidities), age, gender and operation times between the groups. Mean preoperative Hb was 12.9 g/dl and 13.5 g/dl respectively in the DTX and NDTX. 4 and 2 patients respectively required transfusions postoperatively in the DTX and NDTX (p= 0.17). We found no difference with respect to LOS, wound infection, haematoma and reoperation rates between the two groups postoperatively.
Conclusions
Our study suggests that maintaining DT and FXI therapy throughout the perioperative period in high risk patients with femoral neck fractures is not associated with an increased risk of bleeding or complications following hip fracture surgery.
