Preoperative antithrombotic use is associated with delayed mobilization and plural blood transfusions following hip fracture surgery: a case–control study

PURPOSE: Early surgical treatment is important to allow a prompt start for rehabilitation after hip fracture. In patients using antithrombotic drugs, the surgery is often delayed, but it is unclear how this affects early post-operative recovery. METHODS: The course of treatment and early post-operative outcomes of hip fracture patients, aged ≥ 70 years, using either warfarin, direct oral anticoagulants (DOACs), or adenosine diphosphate. (ADP) inhibitors were compared to age- and sex-matched controls not using such drugs, operated during the same observation period at the same hospital. All data were retrospectively collected from electronic medical records. RESULTS: 306 patients (53% of all operations; mean age 87 years, 63% females) were included. Patients using DOACs or ADP inhibitors had their operation later than controls and warfarin users (2 and 2.5 days, respectively, compared to 1 day after admission; p < 0.001). Antithrombotic use was also associated with later mobilization (cases 2nd vs. controls 1st post-operative day; p = 0.004) and greater use of red blood cell (RBC) transfusions (14% of warfarin, 26% of DOAC, and 10% of ADP inhibitor users received ≥ 2 units of RBCs, compared to 5% of controls; p = 0.003). After adjustment for comorbidities, cognition, mobility, and disability, antithrombotic use was associated with RBC transfusions and use of DOACs with delayed surgery and RBC transfusions. There were no differences in 30-day mortality. CONCLUSION: Preoperative use of antithrombotic drugs may delay mobilization and increase the need for RBC transfusions after hip fracture surgery. Delayed surgery and mobilization may lead to worse rehabilitation outcome.