Does ongoing antithrombotic therapy increase the risk of revision after trochanteric fracture fixation? A retrospective cohort study with competing risk analyses

Trochanteric femoral fractures are associated with high morbidity and mortality with a substantial proportion of patients presenting with ongoing antithrombotic therapy (ATT). Evidence regarding the impact of ATT on surgical outcomes and complication rates in this population remains limited. The purpose of this study was to evaluate revision rates, infection risk, surgical timing, and mortality in patients with trochanteric fractures receiving ATT. We retrospectively analyzed 656 patients who underwent cephalomedullary nailing for trochanteric femoral fractures between January 2021 and December 2024. Patients were stratified by pre-injury ATT status. The primary outcome was revision surgery; secondary outcomes included infection requiring revision, surgical timing, and mortality at predefined intervals. Of 656 patients, 319 (48.6%) presented with pre-injury ATT. Revision surgery was required in 33 patients (5.0%) and did not differ significantly between ATT and non-ATT groups (6.0% vs. 4.2%, p = 0.291). Infections occurred in 1.2% of patients, with no excess risk in ATT patients. Patients with pre-injury ATT had significantly higher mortality rates (p = 0.005), although the one-year mortality did not differ significantly (23.8% vs. 23.1%, p = 0.989) between the two groups. Competing risk analyses revealed a significant impact of pre-injury ATT on the mortality (p = 0.004) but not on the revision rates (p = 0.311). In this large cohort, nearly half of all patients with trochanteric fractures were on ATT at admission. ATT was not associated with increased revision or infection risk. While overall mortality was higher in patients receiving ATT, one-year mortality was comparable between groups, indicating that early excess risk is more likely related to age and comorbidity. These findings suggest that ATT itself does not predispose to adverse surgical outcomes.