Introduction: This study aims to investigate whether early surgery in patients under active DOAC (direct oral anticoagulation) therapy with trochanteric, proximal femur fractures leads to higher postoperative blood loss. Material and methods: A prospective cohort study on DOAC patients with trochanteric, proximal femur fractures undergoing early surgery (≤ 24 h) was conducted. Propensity score matching with a retrospective control group of DOAC patients with trochanteric, proximal femur fractures undergoing delayed surgery (> 24 h) was performed for comparison. Key outcome measurements included peri- and postoperative blood loss, transfusion rates, time to surgery and hospital length of stay (LOS). Results: No differences in the median blood loss in patients undergoing early surgery vs. delayed surgery on postoperative day 1 (1078.35 ml (IQR 745.86) vs. 1120.79 ml (IQR 928.50); p = 0.824) or postoperative day 3 (1592.39 ml (IQR 1304.91) vs. 1339.73 ml (IQR 735.57); p = 0.165) was seen. No differences in the rate of blood transfusion (72.5% vs. 68.1%; p = 0.576) or the number of transfused red blood cells (RBCs) (2 units (IQR 2) vs. 2 units (IQR 3); p = 0.567) were detected. A significantly longer median time to surgery, and a significantly longer LOS was seen in the delayed surgery group ( p < 0.001). No difference in the rates of perioperative complications was detected between both groups. Conclusion: Early surgery of trochanteric, proximal femur fractures within 24 h under active DOAC therapy does not increase postoperative blood loss or the need for postoperative blood transfusions but leads to a significantly shorter length of stay. Level of evidence: IIb

Background: Trochanteric femoral fractures are associated with high morbidity and mortality with a substantial proportion of patients presenting with ongoing antithrombotic therapy (ATT). Evidence regarding the impact of ATT on surgical outcomes and complication rates in this population remains limited. The purpose of this study was to evaluate revision rates, infection risk, surgical timing, and mortality in patients with trochanteric fractures receiving ATT. Methods: We retrospectively analyzed 656 patients who underwent cephalomedullary nailing for trochanteric femoral fractures between January 2021 and December 2024. Patients were stratified by pre-injury ATT status. The primary outcome was revision surgery; secondary outcomes included infection requiring revision, surgical timing, and mortality at predefined intervals. Results: Of 656 patients, 319 (48.6%) presented with pre-injury ATT. Revision surgery was required in 33 patients (5.0%) and did not differ significantly between ATT and non-ATT groups (6.0% vs. 4.2%, p = 0.291). Infections occurred in 1.2% of patients, with no excess risk in ATT patients. Patients with pre-injury ATT had significantly higher mortality rates ( p = 0.005), although the one-year mortality did not differ significantly (23.8% vs. 23.1%, p = 0.989) between the two groups. Competing risk analyses revealed a significant impact of pre-injury ATT on the mortality ( p = 0.004) but not on the revision rates ( p = 0.311). Conclusions: In this large cohort, nearly half of all patients with trochanteric fractures were on ATT at admission. ATT was not associated with increased revision or infection risk. While overall mortality was higher in patients receiving ATT, one-year mortality was comparable between groups, indicating that early excess risk is more likely related to age and comorbidity. These findings suggest that ATT itself does not predispose to adverse surgical outcomes.

Background: It remains unclear whether early surgical fixation of trochanteric femoral fractures in patients with direct oral anticoagulation (DOAC) therapy has an impact on the long-term outcome. Methods: A retrospective cohort study on patients with trochanteric femoral fractures and DOAC therapy between 2016 and 2024 was conducted. Patients were divided into two groups according to their time to surgery and matched with age and ASA score as covariates. The primary outcome of interest was the impact of early surgery on the long-term outcome. Results: Of 233 included patients, 102 patients were assigned in each group after propensity score matching. Patients with early surgery had lower in-hospital complication rates (16.0% vs. 26.3%; p = 0.077) and a significantly shorter median length of stay (LOS) (11.5 days (IQR 6) vs. 15 days (IQR 6); p < 0.001). No difference in the rates of revision surgery (9.8% vs. 5.9%; p = 0.298) was observed. Kaplan-Meier curves revealed a significant difference in the mortality rates during the follow-up period ( p = 0.0057) with lower in-hospital (2.0% vs. 6.9%; p = 0.088), 30-day (3.9% vs. 9.8%; p = 0.097) and 1-year mortality rates (20.6% vs. 31.4%; p = 0.079). Conclusion: Early surgical fixation of trochanteric femoral fractures in patients on DOAC therapy leads to a significant reduction in the LOS without increasing the risk for peri- and postoperative complications or the risk for revision surgery. Furthermore, early surgery may positively influence the long-term outcome in this specific cohort of patients.

Zusammenfassung: Venöse Thromboembolien (VTE), eine Krankheitsentität die tiefe Venenthrombosen (TVT) und/oder Lungenembolien (PE) umfasst, gehören in der Orthopädie und Traumatologie zu den häufigsten und potenziell lebensbedrohlichen Komplikationen [1]. Die bislang gültige österreichische Empfehlung zur VTE-Prophylaxe bei muskuloskeletalen Eingriffen aus dem Jahr 2014 [2] bildet die aktuellen evidenzbasierten pharmakologischen und nichtpharmakologischen Strategien nicht mehr adäquat ab. Aktuelle internationale interdisziplinäre Leitlinien zur VTE-Prophylaxe wie von der European Society of Anaesthesiology and Intensive Care (ESAIC) [3] und der Arbeitsgemeinschaft Wissenschaftlich-medizinischer Fachgesellschaften (AWMF) [4] wurden daher unter Berücksichtigung österreichischer Versorgungsstrukturen adaptiert. Insbesondere fehlen bislang klar definierte Kriterien für ein funktionelles Frühmobilisationskonzept im Sinne eines Fast-Track-Programms sowie strukturierte Empfehlungen zur VTE-Prophylaxe bei konservativen orthopädisch-traumatologischen Behandlungen. Zur Erarbeitung praxisorientierter, evidenzbasierter Empfehlungen wurde eine interdisziplinäre Konsensusgruppe aus Vertreter:innen der für dieses Thema relevanten österreichischen Fachgesellschaften einberufen. Das Ziel war, strukturiertere, risikoadaptierte Handlungsempfehlungen unter Berücksichtigung der österreichischen Versorgungsrealität zu formulieren.