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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

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Abstract

Purpose

Managing hip fracture surgery in patients taking clopidogrel is challenging. The optimal timing for surgery remains unclear. Early surgery in such patients potentially increases peri-operative bleeding, whereas delayed surgery has been shown to be associated with worse postoperative outcomes. The aim of this study was to investigate whether a delay to surgery affects total blood loss, bleeding kinetics, blood transfusion requirements, or post-operative outcomes.

Methods

A retrospective monocentric study including all hip fracture patients treated with clopidogrel between 2011 and 2016 (39 patients) was carried out. Patients who underwent delayed surgery after withholding clopidogrel for five days or more, from 2011 to 2013, were compared to patients who benefited from earlier surgical procedures (within 48 hours of admission) from 2014 to 2016.

Results

Total blood loss, amount of blood transfusion and rate of postoperative complications did not differ between the two groups. However, the timing of bleeding was significantly different; blood loss occurred during the pre-operative phase in the delayed surgery group (p < 0.0001), whereas it occurred during the intra-operative phase in the early surgery group (p = 0.005). The length of the hospital stay was significantly shorter for the early surgery group than for the delayed surgery group: 11 ± three versus 15 ± four days (p = 0.004).

Conclusions

Early surgical treatment of hip fracture in patients receiving clopidogrel does not increase the overall red blood cell loss or the transfusion requirement, but may affect the timing of blood transfusion. Hip fracture surgery should preferably be performed without delay in patients taking clopidogrel.

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References

  1. Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289

    Article  CAS  PubMed  Google Scholar 

  2. Moja L, Piatti A, Pecoraro V et al (2012) Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One 7:e46175. doi:10.1371/journal.pone.0046175

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Simunovic N, Devereaux PJ, Sprague S et al (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182:1609–1616. doi:10.1503/cmaj.092220

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fisher A, Srikusalanukul W, Davis M, Smith P (2013) Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links. Clin Interv Aging 8:239–256. doi:10.2147/CIA.S38856

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Harty JA, McKenna P, Moloney D, D’Souza L, Masterson E (2007) Anti-platelet agents and surgical delay in elderly patients with hip fractures. J Orthop Surg 15:270–272. doi:10.1177/230949900701500304

    Article  CAS  Google Scholar 

  6. Johansen A, White J, Turk A (2008) Clopidogrel therapy--implications for hip fracture surgery. Injury 39:1188–1190. doi:10.1016/j.injury.2008.03.018

    Article  PubMed  Google Scholar 

  7. Sim W, Gonski PN (2009) The management of patients with hip fractures who are taking Clopidogrel. Australas J Ageing 28:194–197. doi:10.1111/j.1741-6612.2009.00377.x

    Article  PubMed  Google Scholar 

  8. Manaqibwala MI, Butler KA, Sagebien CA (2014) Complications of hip fracture surgery on patients receiving clopidogrel therapy. Arch Orthop Trauma Surg 134:747–753. doi:10.1007/s00402-014-1981-0

    Article  PubMed  Google Scholar 

  9. Ortel TL (2012) Perioperative management of patients on chronic antithrombotic therapy. Blood 120:4699–4705. doi:10.1182/blood-2012-05-423228

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Iavecchia L, Safiya A, Salat D et al (2016) Impact of implementing a protocol on the perioperative management in patients treated with anti-thrombotics admitted for hip fracture surgery: an observational study. Basic Clin Pharmacol Toxicol 119:476–484. doi:10.1111/bcpt.12615

    Article  CAS  PubMed  Google Scholar 

  11. Network SIG (2009) Management of hip fracture in older people. http://www.sign.ac.uk/pdf/sign111.pdf

  12. Mercuriali F, Inghilleri G (1996) Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin 13:465–478. doi:10.1185/03007999609115227

    Article  CAS  PubMed  Google Scholar 

  13. Brunskill SJ, Millette SL, Shokoohi A et al (2015) Red blood cell transfusion for people undergoing hip fracture surgery. Cochrane Database Syst Rev 21:CD009699. doi:10.1002/14651858.CD009699.pub2

    Google Scholar 

  14. Lavelle WF, Demers Lavelle EA, Uhl R (2008) Operative delay for orthopedic patients on clopidogrel (plavix): a complete lack of consensus. J Trauma 64:996–1000. doi:10.1097/TA.0b013e3180485d23

    Article  CAS  PubMed  Google Scholar 

  15. Doleman B, Moppett IK (2015) Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression. Injury 46:954–962. doi:10.1016/j.injury.2015.03.024

    Article  CAS  PubMed  Google Scholar 

  16. Soo CG, Della Torre PK, Yolland TJ, Shatwell MA (2016) Clopidogrel and hip fractures, is it safe? A systematic review and meta-analysis. BMC Musculoskelet Disord 17:136. doi:10.1186/s12891-016-0988-9

    Article  PubMed  PubMed Central  Google Scholar 

  17. Purushothaman B, Webb M, Weusten A, Bonczek S, Ramaskandhan J, Nanu A (2016) Decision making on timing of surgery for hip fracture patients on clopidogrel. Ann R Coll Surg Engl 98:91–95. doi:10.1308/rcsann.2015.0041

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Mattesi L, Noailles T, Rosencher N, Rouvillain JL (2016) Discontinuation of Plavix(®) (clopidogrel) for hip fracture surgery. A systematic review of the literature. Orthop Traumatol Surg Res 102:1097–1101. doi:10.1016/j.otsr.2016.08.022

    Article  CAS  PubMed  Google Scholar 

  19. Chechik O, Amar E, Khashan M, Kadar A, Rosenblatt Y, Maman E (2012) In support of early surgery for hip fractures sustained by elderly patients taking clopidogrel: a retrospective study. Drugs Aging 29:63–68. doi:10.2165/11598490-000000000-00000

    Article  CAS  PubMed  Google Scholar 

  20. Cox G, Talbot C, Topp K, Templeton P (2009) Clopidogrel and proximal femoral fractures: does timing of surgery affect blood loss and length of admission? A preliminary study prior to multicenter trial. Eur J Trauma Emerg Surg 35:291–295. doi:10.1007/s00068-008-8093-x

    Article  PubMed  Google Scholar 

  21. Zehir S, Zehir R, Sarak T (2015) Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy. Acta Orthop Traumatol Turc 49:249–254. doi:10.3944/AOTT.2015.14.0160

    PubMed  Google Scholar 

  22. Floyd CN, Passacquale G, Ferro A (2012) Comparative pharmacokinetics and pharmacodynamics of platelet adenosine diphosphate receptor antagonists and their clinical implications. Clin Pharmacokinet 51:429–442. doi:10.2165/11630740-000000000-00000

    Article  CAS  PubMed  Google Scholar 

  23. Smith GH, Tsang J, Molyneux SG, White TO (2011) The hidden blood loss after hip fracture. Injury 42:133–135. doi:10.1016/j.injury.2010.02.015

    Article  CAS  PubMed  Google Scholar 

  24. Morris R, Rethnam U, Russ B, Topliss C (2017) Assessing the impact of fracture pattern on transfusion requirements in hip fractures. Eur J Trauma Emerg Surg 43:337-342

  25. Shiga T, Wajima Z, Ohe Y (2008) Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 55:146–154. doi:10.1007/BF03016088

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. AP-HP, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014, Paris, France

    Claire Pailleret, Nadia Rosencher, Charles-Marc Samama & Christophe Baillard

  2. INSERM UMR_S1140, Faculté de Pharmacie, Paris, France

    Claire Pailleret & Charles-Marc Samama

  3. Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    Claire Pailleret, Charles-Marc Samama & Christophe Baillard

  4. Centre Hospitalier Intercommunal André Grégoire, Montreuil, France

    Zakaria Ait Hamou, Violaine Eyraud, François Chilot & Christophe Baillard

Authors
  1. Claire Pailleret
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  2. Zakaria Ait Hamou
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  3. Nadia Rosencher
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  4. Charles-Marc Samama
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  5. Violaine Eyraud
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  6. François Chilot
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  7. Christophe Baillard
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Contributions

C. Pailleret wrote the manuscript; Z. Ait Hamou collected patients’ data and critically read the manuscript; N. Rosencher and C.-M. Samama discussed data results and critically read the manuscript; V. Eyraud and F. Chilot critically read the manuscript; C. Baillard designed the research, analysed the data and wrote the manuscript.

Corresponding author

Correspondence to Claire Pailleret.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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There was no funding.

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Pailleret, C., Ait Hamou, Z., Rosencher, N. et al. A retrospective comparison between delayed and early hip fracture surgery in patients taking clopidogrel: same total bleeding but different timing of blood transfusion. International Orthopaedics (SICOT) 41, 1839–1844 (2017). https://doi.org/10.1007/s00264-017-3571-6

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  • DOI: https://doi.org/10.1007/s00264-017-3571-6

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