The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

The Perioperative Management of Antiplatelet and Anticoagulant Drugs in Hip Fractures: Do the Surgery as Early as Possible

Document Type : CURRENT CONCEPTS REVIEW

Authors
Mohammad Ali Ghasemi 1
Ehsan Ghadimi 1
Ahmad Shamabadi 2
SM Javad Mortazavi 1
1 Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran
2 1 Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran 2 School of Medicine, Tehran University of Medical Science, Tehran, Iran
10.22038/abjs.2021.56396.2800
Abstract
Hip fractures are among the most common fractures operated by orthopedic surgeons. Many elderly patients, who 
account for a significant percentage of hip fractures, suffer from medical conditions requiring antiplatelet and anticoagulant 
administration. Meanwhile, considerable evidence recommends early surgery within 48b hours of admission. We aim 
to review the existing evidence regarding the perioperative management of antiplatelet and anticoagulant drugs in hip 
fractures. It was concluded that surgery for hip fractures in patients with antiplatelet drug consumption should not be 
delayed unless a clear contraindication exists. Active reversal strategies are indicated for patients with hip fractures and 
warfarin therapy. However, evidence for the safety of these agents in pregnancy, breastfeeding state, and adolescence 
has not yet been established. Little data exists about perioperative management of direct-acting oral anticoagulants in 
hip fractures. Early surgery after 12-24 hours of drug cessation has been suggested in studies; however, it should be 
employed cautiously. Despite extensive research, the importance of the issue necessitates additional higher-quality 
studies.
Level of evidence: V
Keywords
Anticoagulant
Antiplatelet agent
Hip fracture
Perioperative management
Vitamin K antagonists
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The Archives of Bone and Joint Surgery
Volume 10, Issue 6
June 2022
Pages 490-500

  • Receive Date 14 April 2021
  • Revise Date 26 September 2021
  • Accept Date 29 September 2021