Preoperative Drug Monitoring in Management of Patients with Hip Fracture on Treatment with Direct Oral Anticoagulants

Figures & data

Table 1 Characteristics of Patients taking DOACs and Controls

	Controls	DOAC	p
Number	206	147
Age (mean±SD)	84.1±8.5	84.7±6	ns
Sex (number and % female)	157 (76.2%)	102 (73.9%)	ns
30 days mortality	6 (2.9%)	1 (0.6%)	ns
Preserved BADL (n, %)
0–4	68 (33%)	53 (36%)	ns
5–6	138 (67%)	94 (64%)
Previous functional capacity
0	55 (26.7%)	46 (34%)	ns
1	151 (73.3%)	91 (66%)
Time to surgery (n, %)
- <48 hours	166 (80.6%)	75 (51%)	<0.0001
- >48 hours	40 (19.4%)	72 (49%)
Mortality	6 (2.9%)	1 (0.6%)	ns
Type of fracture
- femur neck	107 (51.9%)	77 (55.8%)	ns
- per trochanteric	93 (45.2%)	55 (39.8%)
- sub trochanteric	6 (2.9%)	6 (4.3%)
Type of intervention (n, %)
- prosthesis	82 (39.8%)	64 (43%)	ns
- nail	124 (60.2%)	83 (57%)
Hb at admission <10 g/dL (n, %)	43 (20.9%)	41 (29.7%)	ns
Creatinine >1.5 mg/dL (n, %)	14 (6.8%)	6 (4%)	ns
Transfusions (n, %)	95 (46.1%)	54 (39.3%)	ns
Dementia (n, %)	52 (25.2%)	14 (10.1%)	0.002
Hypertension	141 (68.4%)	87 (63%)	ns
Persistent atrial fibrillation	49 (23.8%)	70 (50.7%)	<0.0001
COPD	27 (13.1%)	16 (11.6%)	ns
Diabetes	37 (18.0%)	14 (10.1%)	0.03
Cancer	42 (20.4%)	18 (13%)	0.05
Heart failure	16 (7.8%)	20 (14.5%)	ns
Coronary artery disease	31 (15.0%)	17 (12.3%)	ns
Peripheral artery disease	32 (15.5%)	25 (18.1%)	ns
Comorbidities >2	125 (60.7%)	89 (64.5%)	ns

Abbreviations: BADL, basic activity daily living; Hb, hemoglobin; COPD, chronic obstructive pulmonary disease; ns, not significant.

Table 2 Comparison Between Patients with and without Determination of DOAC Levels

	DOAC Levels Group A2	No DOAC Levels Group A1
	n=73	n=74
Age (mean±SD)	85.1±7	84.6±5.1	ns
Gender M/F (n)	17/56	20/51	ns
Mortality	0 (0%)	1 (0.6%)	ns
Drug
Dabigatran	13 (17%)	28 (38%)	0.002
Rivaroxaban	14 (19%)	19 (26%)
Apixaban	34 (47%)	24 (32%)
Edoxaban	13 (17%)	3 (4%)
DOAC indication
Atrial fibrillation	69 (93%)	68 (90%)	ns
Venous thromboembolism	3 (5%)	6 (8%)
Heart valve prosthesis	1 (2%)	1 (2%)
BADL (n, %)
0–4	21 (28%)	33 (44%)	ns
5–6	52 (72%)	45 (64%)
Time to surgery (n, %)
Days (median±SD)	2.7±1.1	3.6±2.7	0.004
Hours (mean±SD)	62±25	86±46	0.004
- <48 hours	41	34	0.03
- >48 hours	32	40
Type of fracture
- femur neck	30 (41%)	36 (48%)	ns
- per trochanteric	37 (50%)	36 (48%)
- sub trochanteric	6 (9%)	2 (4%)
Length of hospital stay (median±SD, days)	14±4	15±7	0.04
Hb at admission <10 g/dL (n, %)	27 (34.5%)	14 (18.6%)	0.05
Creatinine >1.5 (n, %)	3 (4%)	3 (4%)	ns
Transfusions (n, %)	28 (36.9%)	30 (40%)	ns
Dementia (n, %)	5 (7.7%)	9 (12%)	ns
Hypertension	43 (66.1%)	48 (64%)	ns
COPD	10 (15.3%)	9 (12%)	ns
Diabetes	8 (12.3%)	6 (8%)	ns
Cancer	5 (7.7%)	10 (13.33%)	ns
Heart failure	10 (%)	6 (8%)	ns
Coronary artery disease	10 (13%)	12 (16%)	ns
Peripheral artery disease	15 (23.1%)	11 (14.66%)	ns
Comorbidities >2	47 (64%)	49 (65.33%)	ns

Abbreviations: BADL, basic activity daily living; Hb, hemoglobin; COPD, chronic obstructive pulmonary disease; ns, not significant.

Table 3 DOAC Level >50 ng/mL in Relation to Time Since Last Dose

	Time from Last Dose <48 Hours (n=56)	Time from Last Dose >48 Hours (n=17)	p
Apixaban	13/28	0/6	0.05
Rivaroxaban	0/9	1/5	ns
Dabigatran	4/9	1/4	ns
Edoxaban	0/11	1/2	ns

Abbreviation: ns, not significant.

Table 4 Comparison of Post-Operative Complications Between Patients with and without Determination of DOAC Levels

	Controls N=206	DOAC Levels Assay n=73	No DOAC Levels Assay n=74	p
Delirium	57 (28%)	15 (23.1%)	18 (24%)	ns
Myocardial infarction/myocardial injury	8 (4%)	5 (7.7%)	4 (5.4%)	ns
Stroke	0 (0%)	0 (0%)	0 (0%)	ns
Pneumonia	15 (7%)	8 (12.3%)	7 (9.3%)	ns
Sepsis	1 (0.6%)	0 (0%)	2 (2.7%)	ns
Deep venous thrombosis	12 (6%)	1 (1.5%)	2 (2.7%)	ns
Pulmonary embolism	1 (0.6%)	0 (0%)	0 (0%)	ns
Heart failure	7 (3.5%)	9 (13.8%)	5 (6.7%)	ns
AKI	7 (3.5%)	1 (1.5%)	1 (1.3%)	ns
Respiratory failure	10 (5%)	5 (7.7%)	2 (2.7%)	ns
Hb <7.5 g/dL	21 (10%)	26 (40%)	28 (37.3%)	0.0001

Abbreviation: ns, not significant.