Hip fractures (HF) are a major worldwide public health problem and include two main types of fractures: the intracapsular (cervical) and the extracapsular (trochanteric and subtrochanteric) fractures. HF is common among the elderly and is associated with decline in functional status and substantial increase in morbidity and mortality [1,2]. Direct oral anticoagulants (DOACs) were introduced in 2008 and increasingly widespread since 2010. Their advantages over vitamin K antagonists (VKAs) in terms of practicability and bleeding rates paved the way [3]. Today, atrial fibrillation is the main indication for DOACs use.

Classically, oral anticoagulants (OAC) are stopped prior to surgery due to concern of intraoperative bleeding [4,5]. On the other hand, a meta-analysis of over 190,000 patients found that early hip repair surgery was associated with a lower risk of mortality with a pooled odds ratio of 0.74 (0.67–0.81) [6]. If OAC in HF delays surgical treatment, outcome of patients with HF and preoperative DOACs treatment should be worse because of an increase in mortality and other clinical outcomes such as infection and pressure sores [6]. Data regarding the impact of OAC on mortality are contradicting. A retrospective cohort study from Israel including patients who underwent hip repair surgery between 2014 and 2018 reported, that albeit being associated with longer waiting time for surgery and longer hospitalization, DOAC use appears to be associated with reduced risk of mortality [1]. An analysis from the Danish Multidisciplinary Hip Fracture Registry, including 74,791 HF surgery patients aged ≥ 65 years during 2005–2016 showed that neither preoperative DOAC nor preoperative VKA treatments were associated with increased risk of 30-day postoperative mortality [7].

Now, we hypothesize that preoperative OAC treatment in hospitalized cases with HF in impact mortality in Germany.