Abstract
Background: Early surgical treatment is indicated to reduce mortality and morbidity associated with immobilization due to hip fracture. The judiciousness of postponing surgery to allow withdrawal of clopidogrel and return of normal platelet function (5–10 days) in elderly patients being chronically treated with this antiplatelet medication is a matter of ongoing controversy.
Objective: The purpose of this study was to compare the morbidity and mortality rates in elderly patients receiving long-term treatment with clopidogrel who were operated on with or without delay (due to withdrawal of clopidogrel) following a hip fracture.
Methods: We compared relevant demographic and medical/surgical parameters in patients receiving long-term treatment with clopidogrel who sustained a hip fracture and underwent either early (n = 30, mean ± SD age 81.6 ± 8.7 years, 17 males [57%]) or delayed (n = 30, mean±SD age 83.3±7.1 years, 13 males [43%]) surgical intervention between May 2007 and February 2010.
Results: Both groups were similar with regard to sex, age, co-morbidities and fracture type. The mortality rate was similar in both groups. Patients in the delayed treatment group had more complications associated with prolonged immobilization (pulmonary embolism, pulmonary oedema, decubitus ulcer). Time from admission to surgery and hospitalization stay were significantly longer in the delayed treatment group than in the early treatment group (mean ± SD 7 days and 12 hours ± 2 days and 17 hours compared with 1 day and 16 hours±1 day [p<0.0001] and 17 days and 17 hours±7 days and 5 hours versus 11 days and 2 hours±4 days and 19 hours [p = 0.0002], respectively).
Conclusions: Early surgical intervention for hip fracture in patients receiving long-term treatment with clopidogrel appears to be safe in terms of bleeding complications. It has the potential to enable earlier mobilization and shorter hospitalization and may reduce mortality and complications associated with immobilization.
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References
Wehren LE, Magaziner J. Hip fracture: risk factors and outcomes. Curr Osteoporos Rep 2003; 1: 78–85
Khan SK, Kalra S, Khanna A, et al. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury 2009; 40: 692–7
Haidar R, Taher AT. How long should we delay hip fracture surgery for elderly patients on clopidogrel? Injury. Epub 2010 Jul 14
Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 2008; 55: 146–54
Chassot PG, Delabays A, Spahn DR. Perioperative use of anti-platelet drugs. Best Pract Res Clin Anaesthesiol 2007; 21: 241–56
Lavelle WF, Demers Lavelle EA, Uhl R. Operative delay for orthopedic patients on clopidogrel (Plavix): a complete lack of consensus. J Trauma 2008 Apr; 64(4): 996–1000
Nydick JA, Farrell ED, Marcantonio AJ, et al. The use of clopidogrel (Plavix) in patients undergoing nonelective orthopaedic surgery. J Orthop Trauma 2010; 24: 383–6
Chechik O, Thein R, Fichman G, et al. The effect of clopidogrel and aspirin on blood loss in hip fracture surgery. Injury 2011; 42(11): 1277–82
Palan J, Odutola A, White SP. Is clopidogrel stopped prior to hip fracture surgery: a survey of current practice in the United Kingdom. Injury 2007; 38: 1279–85
Inman DS, Michla Y, Partington PF. Perioperative management of trauma patients admitted on clopidogrel (Plavix): a survey of orthopaedic departments across the United Kingdom. Injury 2007; 38: 625–30
Johansen A, White J, Turk A. Clopidogrel therapy: implications for hip fracture surgery. Injury 2008; 39: 1188–90
Harty JA, McKenna P, Moloney D, et al. Anti-platelet agents and surgical delay in elderly patients with hip fractures. J Orthop Surg (Hong Kong) 2007; 15: 270–2
Thaler HW, Frisee F, Korninger C. Platelet aggregation inhibitors, platelet function testing, and blood loss in hip fracture surgery. J Trauma 2010; 69: 1217–20
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No sources of funding were used to assist in the conduct of this study or the preparation of the manuscript. The authors have no conflicts of interest that are directly relevant to the content of this study.
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Chechik, O., Amar, E., Khashan, M. et al. In Support of Early Surgery for Hip Fractures Sustained by Elderly Patients Taking Clopidogrel. Drugs Aging 29, 63–68 (2012). https://doi.org/10.2165/11598490-000000000-00000
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DOI: https://doi.org/10.2165/11598490-000000000-00000