We are seeking to determine, on a national level, what NHS Trust protocols advise for the management of patients who are taking NOACs (Novel Oral Anticoagulants; e.g. apixaban, rivaroxiban, dabigatran) who sustain a neck of femur fracture which requires surgical fixation.


We note that the AAGBI are about to bring out national guidelines on this.


1. Do you treat patients with neck of femur fractures in your Trust? If yes please complete the questions below: Yes


2. Does your Trust have a protocol for management of patients who sustain neck of femur (NOF) fractures and are taking a Novel Oral Anticoagulant (NOAC)?Yes


3. May we have a copy of your Trust’s protocol? Please find the protocol attached below.


NOAC policy


4. How many hours does your trust advise should be the time interval between last dose of NOAC and surgical fixation of neck of femur fracture? See policy – it depends on the NOAC, renal function, type of surgery, type of anaesthetic, and risks of delaying operation.


5. How many patients with neck of femur fractures does your Trust treat per year? Approximately 330 patients per year.


6. How many of the patients who have been treated in the last year for neck of femur fracture were taking a NOAC? The Trust does not routinely collect this information.


7. What was the average time interval between admission to hospital and time to surgery for patients who were taking NOAC who sustained a neck of femur fracture? The Trust does not routinely collect this information, however, our trauma lists are in the afternoons and our local preferred NOAC is Edoxaban for AF and Apixiban for PE (which are both shorter acting), so we do not usually have to delay patients.


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