# Platelet Aggregation Inhibitors and Anticoagulants Delay Surgery for Hip Fractures
## 3 Results  
A total of 388 patients were identified based on medical coding (ICD-10). From these, 30 subjects were excluded for incomplete data, miscoding, delay due to administrative reasons, non-acute fractures, pathologic fractures, revisions, infections. A total of 358 patient charts were individually reviewed and 7 more patients were excluded due to specific medical conditions. In total, 351 patients (aged 77.53 +/- 9.16 years, 28.8% males) met the inclusion criteria. Of these, 106 (30.2%) were receiving chronic antithrombotic medications (either antiplatelet or anticoagulant). The most common indication for clopidogrel and anticoagulation were atrial fibrillation, followed by stroke, arterial stents, pacemakers and artificial valves. Indication for acetylsalicylic acid was not recorded in the majority of cases. Dosing for acetylsalicylic acid was 100 mg once a day, for clopidogrel 75 mg once per day, for acenocoumarin aiming for a therapeutic target of INR (international normalized ratio) between 2 and 3 and for DOACs based on drug-specific recommended administration. Because of the low number, DOAC patients were analyzed as a group: 11 apixaban, 2 rivaroxaban and 2 dabigatran. The baseline characteristics are presented in Table 1.  
A total of 312 patients (88.89%) underwent surgery in our clinic. The remaining opted for conservative treatment, were deemed unfit for surgery, were transferred to a different clinic or died. The surgically treated DOACs group included: 9 apixaban, 2 rivaroxaban and 2 dabigatran. A total of 75 femoral neck fractures were treated by uncomented hemiarthroplasty and the rest by total arthroplasty (cemented or uncomented). Fractures of the trochanter region were fixed using an intramedullary implant, with a long nail for the subtrochanterior fractures. Transfusions were administered at variable thresholds between 7 and 9g/dL of Hb. The surgically treated patients were classified as follows: Group 1--(study) patients who were on antithrombotic medication at the moment of presentation in the clinic (n = 90) and Group 2--(controls) patients without such medication (n = 222). The demographic and clinical characteristics of the surgically treated patients are presented in Table 2, according to their antithrombotic medication. When compared to Group 2, the median time to surgery was significantly longer in Group 1 (\(p<0.0001\)). The post-hoc analysis showed that those patients treated with clopidogrel, acenocoumarin and DOACs needed significantly more time to surgery than those without such treatment. Patients treated with clopidogrel and DOACs needed significantly more time to surgery compared to patients treated with acetylsalicylic acid (\(p<0.05\)). Because in our service the standard practice is to perform hip arthroplasty only during the day operating time and not during calls (evenings, nights, weekends), time to surgery for these patients is longer than for those with fractures of the trochanteric region. This difference was significantly larger for patients on clopidogrel, acenocoumarin and DOACs. The hospitalization time was also significantly higher in Group 1 patients compared to Group 2 (\(p<0.0001\)). The post-hoc analysis showed a significantly increased hospitalization time in patients treated with clopidogrel, acenocoumarin and DOACs compared with those without medication (\(p<0.05\)). No significant differences were found between the two groups for age, gender, type of fracture/surgery and Hb. The Charlson comorbidity index was significantly higher in Group 1 compared to Group 2 (\(p<0.0001\)). The estimated 10-year survival was significantly lower in Group 1 compared to Group 2 (\(p<0.0001\)). Patients receiving acetylsalicylic acid and acenocoumarin had a significantly higher index and lower estimated survival rate than those without such medication (\(p<0.05\)).