Effects of pre-operative continuing oral anticoagulants or antiplatelets on health outcomes among older patients with hip fracture: a systematic review and meta-analysis
Authors' conclusion
Surgery without discontinuing antiplatelets may be safe. Early surgery after discontinuing antiplatelets could reduce hospital stays without adverse outcomes. Randomized trials are needed to confirm these findings.
Study context
- Population
- Hip fracture patients aged ≥65 years taking antiplatelets or direct oral anticoagulants (DOACs); 13 observational studies from 9 countries; searches to November 2024
- Participants
- 885 patients13 observational studies
- Comparison
- Continuation vs discontinuation of antiplatelets or DOACs before hip fracture surgery; early vs delayed surgery after discontinuation
- Outcome
- Transfusion rates
Methodological detailsrandom-effects model, Newcastle-Ottawa Scale risk of bias
- Random-effects model
- Newcastle-Ottawa Scale risk of bias
Pooled result
As reported in the abstract
Transfusion rates in patients who continued the medication: no significant differences, OR
0.87
95% CI 0.37 to 2.03
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| Transfusion, DOAC users: earlyvs delayed surgery | OR 1.09 (95% CI 0.56–2.09) | |
| 30-day mortality, DOAC users: earlyvs delayed surgery | OR 1.53 (95% CI 0.45–5.19) | |
| Transfusion and in-hospital mortality, antiplatelet users: surgery within 48 h of discontinuation vs delayed surgeryEarly surgeryvs Delayed surgeryNo increase | OR (transfusion) 0.75 (95% CI 0.04–13.73) | |
| Transfusion and in-hospital mortality, antiplatelet users: surgery within 48 h of discontinuation vs delayed surgeryEarly surgeryvs Delayed surgeryNo increase | OR (in-hospital mortality) 0.49 (95% CI 0.02–13.52) | |
| 0.050.21520Ratio (log scale) |
| Outcome | Mean difference (days) (95% CI) |
|---|---|
| Hospital stay, antiplatelet users: surgery within 48 h of discontinuation vs delayed surgery | - 5.71 (- 8.36 to - 3.06) |
Original publication
Effects of pre-operative continuing oral anticoagulants or antiplatelets on health outcomes among older patients with hip fracture: a systematic review and meta-analysis. Osteoporos Int. Published 7 August 2025. doi:10.
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