{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:53:05Z","timestamp":1788454385011,"version":"build-2803163510"},"reference-count":23,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,11]],"date-time":"2024-08-11T00:00:00Z","timestamp":1723334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The increasing numbers of already endemic hip fractures in the elderly taking anticoagulants is a growing concern for daily surgical practice. Ample evidence demonstrates decreased morbidity and mortality in the general population when surgery is performed at the earliest possibility. Direct anticoagulants are relatively new drugs that can cause increased perioperative bleeding. Current guidelines propose stopping the drug to allow for elimination before performing elective surgery. Optimal management in urgent hip surgery is presently based on expert opinion with arbitrary cut-offs. In this study, we investigated whether patients taking direct anticoagulants would benefit from early surgical treatment, regardless of the timing since last intake. Methods: A total of 340 patients were included in the analysis, of which 59 took direct anticoagulants. The primary outcomes were time to surgery, postoperative transfusion rate, postoperative hemoglobin decrease, length of postoperative in-hospital stay (LOPS), revision rate, and complication rate (medical and surgical). Results: Our findings showed that the anticoagulated group was fit for discharge earlier when operated on within 24 h (p = 0.0167). Postoperative transfusion and medical complication rate tended to be lower when the operation was performed earlier. Revision rate due to hematomas were higher in the direct anticoagulant group without a relationship to time to surgery. Simple linear regression could not determine a relationship between postoperative hemoglobin change and time to surgery. Conclusions: We suggest that directly anticoagulated patients needing hip fracture surgery must be considered for early surgery.<\/jats:p>","DOI":"10.3390\/jcm13164707","type":"journal-article","created":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T11:23:46Z","timestamp":1723461826000},"page":"4707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Early Hip Fracture Surgery in Patients Taking Direct Oral Anticoagulants Improves Outcome"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6254-4108","authenticated-orcid":false,"given":"Benjamin K.","family":"Devlieger","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology Westpfalz-Klinikum, 67655 Kaiserslautern, Germany"},{"name":"Department of Orthopaedics and Traumatology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pol M.","family":"Rommens","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Baranowski","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany"},{"name":"Klinikum Anbach, 91522 Ansbach, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany"},{"name":"Department of Orthopaedics and Traumatology, University Hospital of Lausanne, CH-1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,11]]},"reference":[{"key":"ref_1","first-page":"426","article-title":"Trends in Direct Oral Anticoagulant (DOAC) Use: Health Benefits and Patient Preference","volume":"76","author":"Koops","year":"2018","journal-title":"Neth. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s11999-016-5056-0","article-title":"Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?","volume":"475","author":"Lawrence","year":"2017","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Aigner, R., Buecking, B., Hack, J., Schwenzfeur, R., Eschbach, D., Einheuser, J., Schoeneberg, C., Pass, B., Ruchholtz, S., and Knauf, T. (2022). Effect of Direct Oral Anticoagulants on Treatment of Geriatric Hip Fracture Patients: An Analysis of 15,099 Patients of the AltersTraumaRegister DGU\u00ae. Medicina, 58.","DOI":"10.3390\/medicina58030379"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1093\/europace\/euv309","article-title":"Updated European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Anticoagulants in Patients with Non-Valvular Atrial Fibrillation","volume":"17","author":"Heidbuchel","year":"2015","journal-title":"Europace"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Klestil, T., R\u00f6der, C., Stotter, C., Winkler, B., Nehrer, S., Lutz, M., Klerings, I., Wagner, G., Gartlehner, G., and Nussbaumer-Streit, B. (2018). Impact of Timing of Surgery in Elderly Hip Fracture Patients: A Systematic Review and Meta-Analysis. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-32098-7"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/2151458515572697","article-title":"A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2","volume":"6","author":"Mears","year":"2015","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/BOT.0000000000001146","article-title":"Outcomes of Early Surgical Intervention in Geriatric Proximal Femur Fractures among Patients Receiving Direct Oral Anticoagulation","volume":"32","author":"Franklin","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.injury.2018.10.033","article-title":"Safety of Urgent Hip Fracture Surgery Protocol under Influence of Direct Oral Anticoagulation Medications","volume":"50","author":"Schermann","year":"2019","journal-title":"Injury"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1177\/1120700019841351","article-title":"New Drug, New Problem: Do Hip Fracture Patients Taking NOACs Experience Delayed Surgery, Longer Hospital Stay, or Poorer Outcomes?","volume":"30","author":"Hourston","year":"2020","journal-title":"Hip Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.thromres.2015.09.017","article-title":"The Impact of Oral Anticoagulation on Time to Surgery in Patients Hospitalized with Hip Fracture","volume":"136","author":"Tran","year":"2015","journal-title":"Thromb. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1111\/bjh.14344","article-title":"British Committee of Standards for Haematology Peri-Operative Management of Anticoagulation and Antiplatelet Therapy","volume":"175","author":"Keeling","year":"2016","journal-title":"Br. J. Haematol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s00402-020-03701-2","article-title":"Time to Surgery and Complications in Hip Fracture Patients on Novel Oral Anticoagulants: A Systematic Review","volume":"142","author":"Cheung","year":"2022","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"321","DOI":"10.52628\/87.2.17","article-title":"The Impact of Direct Oral Anti-Coagulants on Hip Fracture Management: A Systematic Review and Meta-Analysis","volume":"87","author":"Holmes","year":"2021","journal-title":"Acta Orthop. Belg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1097\/BOT.0000000000002251","article-title":"Delayed Surgery Does Not Reduce Transfusion Rates in Low-Energy Hip Fractures on Direct Oral Anticoagulants","volume":"36","author":"Levack","year":"2022","journal-title":"J. Orthop. Trauma"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e252","DOI":"10.1097\/OI9.0000000000000252","article-title":"Early Hip Fracture Surgery Is Safe for Patients on Direct Oral Anticoagulants","volume":"6","author":"Kolodychuk","year":"2023","journal-title":"OTA Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1007\/s41999-020-00319-w","article-title":"Do Direct Oral Anticoagulants (DOACs) Cause Delayed Surgery, Longer Length of Hospital Stay, and Poorer Outcome for Hip Fracture Patients?","volume":"11","author":"Dybvik","year":"2020","journal-title":"Eur. Geriatr. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1016\/j.injury.2019.09.011","article-title":"Impact of Oral Anticoagulation on Proximal Femur Fractures Treated within 24\u2009h-A Retrospective Chart Review","volume":"50","author":"Schuetze","year":"2019","journal-title":"Injury"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1097\/BOT.0000000000001329","article-title":"Impact of Direct Oral Anticoagulants in Patients With Hip Fractures","volume":"33","author":"Bruckbauer","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1302\/0301-620X.88B8.17534","article-title":"Hidden Blood Loss after Surgery for Hip Fracture","volume":"88","author":"Foss","year":"2006","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1007\/s00068-021-01670-8","article-title":"The Factors That Affect Blood Loss in Intertrochanteric Fractures Treated with Proximal Femoral Nail in the Elderly","volume":"48","author":"Bilekli","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e020625","DOI":"10.1136\/bmjopen-2017-020625","article-title":"Should Surgery Be Delayed in Patients Taking Direct Oral Anticoagulants Who Suffer a Hip Fracture? A Retrospective, Case-Controlled Observational Study at a UK Major Trauma Centre","volume":"8","author":"Mullins","year":"2018","journal-title":"BMJ Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2151459320944854","DOI":"10.1177\/2151459320944854","article-title":"Early Surgical Fixation for Hip Fractures in Patients Taking Direct Oral Anticoagulation: A Retrospective Cohort Study","volume":"11","author":"King","year":"2020","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bl\u00e4sius, F.M., Laubach, M., Andruszkow, H., L\u00fcbke, C., Lichte, P., Lefering, R., Hildebrand, F., and Horst, K. (2021). Impact of Anticoagulation and Antiplatelet Drugs on Surgery Rates and Mortality in Trauma Patients. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-94675-7"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4707\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:34:50Z","timestamp":1760110490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,11]]},"references-count":23,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jcm13164707"],"URL":"https:\/\/doi.org\/10.3390\/jcm13164707","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,11]]}}}