Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A Systematic Review and Meta-analysis

Abstract

Background: Hip fractures are common and account for a large proportion of orthopaedic surgical admissions in elderly patients. However, determining the timing for surgery has been controversial for patients who develop with hip fractures while on antiplatelet treatment. Methods: Computerized databases for studies published from the inception date to January 2020, including the Cochrane Library, PubMed (Medline), EMBASE, Web of Science TM , ClinicalTrials, ClinicalKey and Google Scholar, were searched using the keywords “Hip AND Fracture”, “Antiplatelet”, “Antithrombocyte”, “Platelet aggregation inhibitors”, “Aspirin”, “Plavix”, and “Clopidogrel”. Results: In total, 2328 initial articles were identified. Twenty-four studies with 5423 participants were ultimately included in our analysis. Early surgery was associated with an increased transfusion rate in the antiplatelet group compared to the non-antiplatelet group (OR = 1.21; 95% CI, 1.01 to 1.44; p = 0.03). Early surgery for hip fracture patients on antiplatelet therapy was associated with a greater decrease in haemoglobin compared to delayed surgery (WMD = 0.75; 95% CI, 0.50 to 1.00; p < 0.001). However, early surgery appeared to decrease the length of hospitalization (WMD = -6.05; 95% CI, -7.06 to -5.04; p < 0.001) and mortality (OR = 0.43; 95% CI, 0.23 to 0.79; p = 0.006). Conclusion: It is unnecessary to delay surgery to restore platelet function when patients with hip fractures receive antiplatelet therapy. Furthermore, early surgery can significantly reduce mortality and hospital stay, which is conducive to patient recovery. Future randomized trials should determine whether the results are sustained over time.

Experience in the perioperative management of patients with hip fracture in southwestern Colombia. Retrospective cohort study

“…In accordance with the current evidence, it is clear that there is no need to adjourn surgery in patients with HF receiving antiplatelet therapy as monotherapy or dual anti-aggregation with aspirin plus a P2Y12 receptor inhibitor such as clopidogrel, prasugrel and ticagrelor. (28,29) In patients anticoagulated with warfarin or direct oral anticoagulants, the surgical procedure should not be deferred for more than 48 hours, individualizing the approach for each patient. (30,31) No significant statistical relationship was found in this study between the history of anticoagulation and/or antiplatelet therapy with the outcomes assessed.…”