Clopidogrel and Proximal Femoral Fractures: Does Timing of Surgery Affect Blood Loss and Length of Admission? A Preliminary Study Prior to Multicenter Trial

Cox, George E.; Talbot, Charlie; Topp, Katerina; Templeton, Peter

doi:10.1007/s00068-008-8093-x

Cited by 11 publications

(11 citation statements)

References 23 publications

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“…The odds ratio was non-significant at 0.44 (95% CI: 0.15-1.30). Cox et al [31] reported mean units transfused; this was non-significant between early and delayed surgery groups (p > 0.05).…”

Section: Blood Transfusionmentioning

confidence: 81%

“…On meta-regression, neither mean age (p = 0.268) nor percentage female (p = 0.963) could predict differences in mortality. Three studies [31,55,58] reported mortality outcomes in early versus delayed surgery. Overall, the odds ratio for mortality was 0.61 (95% CI: 0.11-3.25).…”

Section: Studymentioning

confidence: 99%

“…Thirty-one studies deemed to be relevant to the research question underwent full text review. Studies were excluded for the following reasons: Japanese language (1) [35]; paper was unavailable for review (1) [33]; clopidogrel group had a mean time to surgery of >7 days and was therefore felt to be non-comparable (2) [38,39]; letters (3) [36,40,41]; no comparison group (2) [42,43]; no relevant data (1) [34]; abstract only (1) [44]; surveys (3) [22,23,24]; no clopidogrel group (1) [45]; included patients on other antiplatelets (1) [32,46] and early surgery >48 h (2) [47,48] This left 12 studies, which were included in the review [30,31,[49][50][51][52][53][54][55][56][57][58].…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…1). Nine additional papers were identified after searching of study references and articles that had cited identified studies [24,[30][31][32][33][34][35][36][37]. Thirty-one studies deemed to be relevant to the research question underwent full text review.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

Doleman

Moppett

2015

Injury

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Section: Blood Transfusionmentioning

confidence: 81%

Section: Studymentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

Doleman

Moppett

2015

Injury

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“…The percentage of hip fracture patients on antiplatelet medication in our study (approximately 3%) is comparable with others. 25 Owing to the small number of patients on antiplatelet medications, data had to be collected over three years. However, the number of such patients is likely to rise in the future.…”

Section: Study Limitationsmentioning

confidence: 99%

Decision making on timing of surgery for hip fracture patients on clopidogrel

Purushothaman

Webb

Weusten

et al. 2016

annals

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Patients taking clopidogrel who sustain a fractured neck of femur pose a challenge to orthopaedic surgeons. The aim of this study was to determine whether delay to theatre for these patients affects drop in haemoglobin levels, need for blood transfusion, length of hospital stay and 30-day mortality. A retrospective review of all neck of femur patients admitted at two centres in the North East of England over 3 years revealed 85 patients.Patients were divided into two groups depending on whether they were taking clopidogrel alone (C) or with aspirin (CA). Haemoglobin drop was significantly different in the CA group that was operated on early (CA1) versus the group for which surgery was delayed by over 48 hours (CA2): 3.3g/dl and 1.9g/dl respectively (p=0.01). The mean inpatient stay in group C was 35.9 days while in group CA it was 19.9 days (p=0.002). The mean length of stay in group CA2 (26.7 days) was significantly longer than for CA1 patients (14.1 days) (p=0.01). There were no significant differences in mortality or wound complications.Hip fracture patients on clopidogrel can be safely operated on early provided they are medically stable. Bleeding risk should be borne in mind in those patients on dual therapy with aspirin. KEYWORDSHip fracture -Clopidogrel -Aspirin -Delay to surgery Clopidogrel is a thienopyridine that irreversibly binds to platelets inhibiting aggregation. It is used commonly with or without aspirin for primary and secondary prevention of cardio and cerebrovascular disease. Given the prevalence of coronary disease, advances in coronary intervention for stable and unstable cardiac as well as stroke disease, it is no surprise that the number of patients admitted to hospital on dual antiplatelet therapy (DAPT) as well as other newer anticoagulant agents is rising. The timing of operative intervention for hip fracture patients on antiplatelet agents poses a significant challenge to the multidisciplinary team managing these complex patients. Hip fracture patients tend to be older with co-morbidities. There is consensus in the orthopaedic community that if feasible and indicated, surgery should be carried out at the earliest opportunity followed by early mobilisation. Patients taking DAPT, clopidogrel alone or other anticoagulants have an elevated bleeding risk in the perioperative period. These patients have a higher risk of bleeding if operated on early while delaying surgery is associated with increased risk of morbidity and mortality. There is a lack of consensus among orthopaedic teams for timing of operation, with some surgeons choosing to stop their patients' antiplatelet treatment and delay operative management. 3,4 There is a paucity of literature reporting the risks and benefits of operating on these patients. 5,6 This study sought to determine whether time to surgery influenced factors including drop in haemoglobin (Hb) levels, need for blood transfusion, duration of inpatient stay and 30-day mortality for patients who were admitted with a neck of femur fracture while taking cl...

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A retrospective comparison between delayed and early hip fracture surgery in patients taking clopidogrel: same total bleeding but different timing of blood transfusion

Pailleret

Hamou

Rosencher

et al. 2017

International Orthopaedics (SICOT)

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Clopidogrel and Proximal Femoral Fractures: Does Timing of Surgery Affect Blood Loss and Length of Admission? A Preliminary Study Prior to Multicenter Trial

Abstract: Patients should be considered for early operation provided there are no additional bleeding risk factors, as although postoperative hemoglobin is lower, mortality and complication rates are similar, and length of admission is shorter.

Cited by 11 publications

References 23 publications

Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

Decision making on timing of surgery for hip fracture patients on clopidogrel

A retrospective comparison between delayed and early hip fracture surgery in patients taking clopidogrel: same total bleeding but different timing of blood transfusion

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