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OBJECTIVES To examine the relationship between anticoagulant and antiplatelet drugs and surgical blood loss for geriatric patients undergoing cephalomedullary nail fixation of extracapsular proximal femur fractures. DESIGN Multicenter retrospective cohort study using bivariate and multivariable regression analyses. SETTING Two level-1 trauma centers. PATIENTS 1442 geriatric (ages 60-105) patients undergoing isolated primary intramedullary fixation of non-pathologic extracapsular hip fractures from 2009 - 2018 including 657 taking an antiplatelet drug alone (including aspirin), 99 taking warfarin alone, 37 taking a direct oral anticoagulant (DOAC) alone, 59 taking an antiplatelet drug and an anticoagulant, and 590 taking neither. INTERVENTION Cephalomedullary nail fixation. MAIN OUTCOME MEASUREMENTS Blood transfusion and calculated blood loss. RESULTS More patients taking antiplatelet drugs required a transfusion than controls (43% versus 33%, p < 0.001) whereas patients taking warfarin or DOACs did not (35% or 32% versus 33%). Median calculated blood loss was increased in patients taking antiplatelet drugs (1275 mL versus 1059 mL, p < 0.001) but not in patients taking warfarin or DOACs (913 mL or 859 mL versus 1059 mL). Antiplatelet drugs were independently associated with an odds ratio of transfusion of 1.45 (95% CI 1.1 - 1.9) in contrast with 0.76 (95% CI 0.5 - 1.2) for warfarin and 0.67 (95% CI 0.3 - 1.4) for DOACs. CONCLUSIONS Geriatric patients taking warfarin (incompletely reversed) or DOACs lose less blood during cephalomedullary nail fixation of hip fractures than those taking aspirin. Delaying surgery to mitigate anticoagulant-related surgical blood loss may be unwarranted. LEVEL OF EVIDENCE Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.