Poor prognosis after surgery for intertrochanteric fracture in elderly patients with clopidogrel treatment

Zhang, Jianzheng; Chen, Xiaobin; Wang, Juan; Li, Zhi; Wang, Xiaowei; Ren, Jixin; Sun, Tiansheng

doi:10.1097/md.0000000000008169

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…However, a higher drop in Hb is expected in those on dual APA therapy [ 773 , 774 ]. In contrast, in another study, patients who underwent surgery for intertrochanteric fracture while on clopidogrel had a poorer prognosis compared with controls: intraoperative blood transfusion, ICU and hospital stays and 1-year mortality were higher, despite having the same rate of postoperative complications [ 775 ].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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“…Zhang et al [ 19 ] reported that continuation of preoperative clopidogrel for patients undergoing intramedullary nailing for an intertrochanteric fracture resulted in higher chances of intraoperative transfusion, increased ICU admission and total duration of hospitalization, and a lower one-year survival rate, leading to poor prognosis. Our results were consistent with those of Zhang et al in terms of total transfusion volume and ICU admission rates.…”

Section: Discussionmentioning

confidence: 99%

Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?

Jang

Kwak

Kim

et al. 2019

BMC Musculoskelet Disord

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BackgroundAntiplatelet medication has been frequently performed in elderly patients with hip fracture, because of comorbidities. This observational cohort study was to evaluate the effect of continuous perioperative antiplatelet medication on the outcomes after cephalomedullary nailing (CMN) in elderly patients with a proximal femur fracture.MethodsOne hundred and sixty-two consecutive patients aged ≥70 years undergoing CMN for proximal femur fracture between January 2015 and January 2017 were recruited. Of the 162 patients, 47 (study group) taking antiplatelets preoperatively due to comorbidities were compared with 107 (control group) who were not on antiplatelets. 8 patients taking anticoagulant medication were excluded. Postoperative hemoglobin (Hb) and hematocrit (Hct) levels, transfusion amount and estimated blood loss (EBL), occurrence of venous thromboembolism (VTE) and delirium, intensive care unit (ICU) admission, complications, length of hospital stay, readmission, and in-hospital and 1-year mortalities were measured and compared between the two groups.ResultsA higher number of patients in the study group had concomitant cardiovascular (p = 0.006) and endocrinologic (p = 0.004) diseases, received perioperative transfusion (p = 0.003), and were admitted to ICU postoperatively (p = 0.014). However, there were no significant differences in postoperative Hb and Hct levels, EBL, length of hospital stay, and the incidences of VTE and delirium between the two groups. In addition, in-hospital and 1-year mortalities as well as postoperative complications showed no significant differences between both groups.ConclusionsCMN can be performed without delay in elderly patients with proximal femoral fracture receiving antiplatelet therapy prior to admission without discontinuing antiplatelets, and is as safe as in patients who are not on antiplatelet medication. However, more caution is required with respect to transfusions and ICU care after surgery in these patients.Electronic supplementary materialThe online version of this article (10.1186/s12891-019-2504-5) contains supplementary material, which is available to authorized users.

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“…Approximately 30-50% of patients with hip fractures have cardiovascular comorbidity that requires antithrombotic treatment (antiplatelet, vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs) [126]. Early surgery (within 48 h) has been proven to reduce complications and mortality at 30 days and 1 year in hip fracture patients even if receiving antithrombotic treatment [127][128][129], although these drugs can potentially interfere with regional anaesthesia or increase perioperative bleeding. Choosing the optimal moment for surgery should thus balance thrombotic and bleeding risks with the risks of delayed surgery and the benefits and risks of spinal anaesthesia.…”

Section: Perioperative Antithrombotic Managementmentioning

confidence: 99%

Orthogeriatric Care: Reviewing Improvements in Outcomes

Tarazona-Santabalbina¹,

Ojeda-Thies²,

Rodríguez³

et al. 2021

Preprint

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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Poor prognosis after surgery for intertrochanteric fracture in elderly patients with clopidogrel treatment

Cited by 13 publications

References 23 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?

Orthogeriatric Care: Reviewing Improvements in Outcomes

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