Early surgery within 24 hours in Patients with Hip Fracture on DOAC safe and beneficial: study

Surgery in patients with hip fracture on direct oral anticoagulants (DOACs) is frequently delayed because of concerns about bleeding risk. However, evidence supporting such delays remains limited, and institutional practices vary widely.Schiepers et al conducted a study to determine whether early surgery within 24 hours is associated with a greater perioperative hemoglobin decrease compared with delayed surgery after 24 hours or more in patients with hip fracture on DOACs. The article has been published in ‘JBJS open access.’
This multicenter retrospective cohort study included patients with hip fracture aged more than70 years on DOACs at admission across 5 hospitals. Patients were stratified by time to surgery: <24 hours (early surgery) versus >24 hours (delayed surgery). The primary outcome was hemoglobin decrease in mmol/L. Secondary outcomes included a hemoglobin decrease of more than 2 mmol/L, preoperative and postoperative blood transfusion, packed red blood cells administered, postoperative anemia, hospital length of stay, and in-hospital and 30-day mortality. Multiple linear regression and multiple imputation were applied.
The key findings of the study were:
• Among the 875 patients included, 504 underwent early surgery and 371 underwent delayed surgery.
• Early surgery was associated with a lower median decrease in hemoglobin levels (0.6 vs. 0.9 mmol/L, p < 0.001); with an adjusted mean difference of -0.25 mmol/L (95% CI, 20.37 to 20.13, p < 0.001).
• No significant differences were observed in a hemoglobin decrease of more than 2 mmol/L, blood transfusion rates, postoperative anemia, or in-hospital and 30-day mortality.
• Early surgery was associated with a shorter hospital length of stay median 2 days (95% CI, 2-3; p < 0.001).
Conclusions: Early surgery within 24 hours was associated with a modestly smaller hemoglobin decrease and a shorter hospital length of stay, without an increased blood transfusion rate or mortality rates compared with delayed surgery. These findings suggest that early surgery in patients with hip fracture on DOACs may be safe and potentially beneficial in reducing hospital length of stay.
Level of Evidence: Level III. For further details on the article refer to:
Impact of Early (<24 Hours) vs. Delayed (>24 Hours) Surgery on Hemoglobin Decrease in Patients with Hip Fracture on Direct Oral Anticoagulants
Schiepers et al
JBJS Open Access 2026:e25.00334.
http://dx.doi.org/10.2106/JBJS.OA.25.00334