Abstract：
Hip fracture is a common serious injury among older adults, yet the management of hip fractures for patients taking direct oral anticoagulants remains inconsistent worldwide. Drawing from a synthesis of available evidence and expert opinion, best practice approaches for managing patients with a hip fracture and who are taking direct oral anticoagulants pre-operatively were considered by a working group of the Fragility Fracture Network Hip Fracture Audit Special Interest Group. The literature and related clinical guidelines were reviewed and a two-round modified Delphi study was conducted with a panel of experts from 16 countries and involved seven clinical specialities. Four consensus statements were achieved: peripheral nerve blocks can reasonably be performed on presentation for patients with hip fracture who are receiving direct oral anticoagulants; hip fracture surgery can reasonably be performed for patients taking direct oral anticoagulants < 36 h from last dose; general anaesthesia could reasonably be administered for patients with hip fracture and who are taking direct oral anticoagulants < 36 h from last dose (assuming eGFR > 60 ml.min-1.1.73 m-2); and it is generally reasonable to consider recommencing direct oral anticoagulants (considering blood loss and haemoglobin) < 48 h after hip fracture surgery. No consensus was achieved regarding timing of spinal anaesthesia. The consensus statements were developed to aid clinicians in their decision-making and to reduce practice variations in the management of patients with hip fracture and who are taking direct oral anticoagulants. Each statement will need to be considered specific to each individual patient\'s treatment.
摘要：
髋部骨折是老年人常见的严重损伤，然而,对于直接口服抗凝药的髋部骨折患者的治疗在全球范围内仍不一致.根据现有证据和专家意见的综合，脆性骨折网络髋部骨折审核特别兴趣小组的一个工作组考虑了治疗髋部骨折和术前直接口服抗凝剂的最佳实践方法.回顾了文献和相关的临床指南，并与来自16个国家的专家小组进行了两轮改良的Delphi研究，涉及七个临床专业。达成了四个共识：对于接受直接口服抗凝药的髋部骨折患者，可以合理地进行周围神经阻滞；对于在末次剂量后<36h服用直接口服抗凝药的患者，可以合理地进行髋部骨折手术；对于在末次剂量后<36h服用直接口服抗凝药的髋部骨折患者，可以合理地进行全身麻醉（假设eGFR>60ml。min-1.1.73m-2）；并且在髋部骨折手术后<48h考虑重新使用直接口服抗凝剂（考虑失血和血红蛋白）通常是合理的。关于脊髓麻醉的时机没有达成共识。制定共识声明是为了帮助临床医生做出决策，并减少髋部骨折患者和直接服用口服抗凝剂的管理实践差异。每个陈述都需要考虑到每个患者的治疗。
