Anticoagulation Treatment for Elderly Patients With Femoral Neck Fractures: Is There a Difference Outcome between Warfarin and Novel Oral Anticoagulants Treated Patients?

Introduction: Fragility fractures at the hip are associated with a high morbidity and mortality. Early surgical treatment is recommended to reduce complication rates and duration of hospitalization. Yet, patients treated with anticoagulants pose a challenge when planning surgical treatment. While the action of vitamin K antagonists (VKA) can be reversed with vitamin K or blood products, for the direct oral anticoagulants (DOAC) antidote drugs are only now becoming available and are not commonly used. We aimed to compare the outcomes of patients receiving VKA and DOAC while hospitalized and in the following year, to observe whether the irreversibility of DOAC leads to different patient outcomes.

Methods: a retrospective case-control study comparing consecutive femoral neck fracture patients, receiving either VKA or DOAC between January 2012 and June 2016. Primary outcome was 1-year survival. Secondary outcomes were time to surgery (TTS), in hospital complications, a need for blood transfusions and recurrent hospitalizations for any cause.

Results: 102 and 45 patients (103 and 47 fractures) treated with VKA and DOAC respectively were included. Charlson co-morbidity score was worse for the DOAC group (7.6±2.1 vs. 6.5 ±2.4, p.=0.035). There was no significant 1-year mortality difference between groups (26.2% for the VKA group vs. 19.1% for the DOAC group, p=0.413). No difference was found in TTS, the average number of in-hospital complications, the number of blood transfusions required or the 1-year re-admission rate.

Conclusions: DOAC and VKA have a similar safety profile in surgically treated patients with femoral neck fractures.