Authors
Jannis Christoffel, Marc Maegele
Published in
Unfallchirurgie (Heidelberg, Germany). Jul 15, 2026. Epub Jul 15, 2026.
Abstract
Proximal femur fractures are common injuries in older adults and, according to guidelines, require prompt surgical treatment. With the increasing use of direct oral anticoagulants (DOACs), uncertainties have arisen regarding the timing of surgery, the risk of bleeding, and perioperative management.
The aim is to evaluate the influence of DOACs on the timing of surgery, the risk of bleeding, and the safety of early surgical treatment for proximal femur fractures.
Narrative review of the current literature, systematic reviews, meta-analyses, and current guideline recommendations (AWMF S3-LL).
Patients on DOACs sometimes exhibit significantly prolonged time to surgery (TTS), often due to uncertainties in perioperative management. However, prolonged TTS is not consistently associated with increased mortality. The majority of studies show no significant difference in blood loss or transfusion requirements between DOAC-treated and nonanticoagulated patients when treated early. Calibrated laboratory methods are the gold standard, but are only available to a limited extent. Prothrombin complex concentrate (PPSB) and antidotes allow for reversal; however, the latter sometimes carry specific risks.
Based on current data, early surgery for proximal femur fractures can be performed despite DOAC use, particularly for minimally invasive procedures with a low risk of bleeding. Individual risk assessment, taking into account comorbidities, residual DOAC levels, and the type and extent of the procedure, remains crucial.
PMID:
42455168
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.
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