- Podcast
- 02/02/2022
- UK
Episode 11 - Should We Delay Hip Fracture Surgery for DOACs?
Description
In this episode of the Bone and Joint 360 podcast, host Tim Coughlin engages with Professor Ian Moppett, a specialist in Anesthesia and Perioperative Medicine at the University of Nottingham, to discuss a systematic review and meta-analysis on the reversal of direct oral anticoagulants (DOACs) in adult hip fracture patients. They delve into the implications of DOACs in clinical practice, especially how these anticoagulants may delay surgical procedures for hip fractures, which are common and painful injuries requiring prompt treatment. Moppett estimates that about 10% of hip fracture patients in the UK are on anticoagulants, and emphasizes a growing trend towards DOAC use globally.
The podcast explores the pharmacodynamics of DOACs, noting their typical anticoagulant effects lasting roughly 24 hours, and considers the options for reversal—namely, waiting for the drug effects to subside or using specific antidotes, though the latter are not widely recommended. Moppett presents findings from the study indicating a notable decrease in time to surgery (from 46 hours to 25 hours) in patients who did not wait for DOAC effects to wear off. He argues for a prompt surgical approach based on evidence suggesting that quicker surgeries can lead to better patient outcomes.
They also discuss the challenges surrounding anesthesia and the concerns regarding bleeding complications, reassuring listeners that the current evidence does not support an increased risk of such complications from proceeding with surgery in the context of anticoagulated patients. The conversation consistently underscores the importance of institutional policies surrounding the treatment of hip fractures, advocating for a standardized approach to improve patient care while acknowledging necessary individual considerations.