Safety of early surgery for geriatric hip fracture patients taking clopidogrel: a retrospective case-control study of 120 patients in China.
10.1097/CM9.0000000000001668
- Author:
Ming-Hui YANG
1
;
Bo LI
1
;
Dong-Chen YAO
1
;
Yan ZHOU
2
;
Wen-Chao ZHANG
2
;
Geng WANG
2
;
Ping ZHANG
3
;
Shi-Wen ZHU
1
;
Xin-Bao WU
1
Author Information
1. Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing 100035, China.
2. Department of Anesthesiology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing 100035, China.
3. Department of Geriatric Medicine, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing 100035, China.
- Publication Type:Journal Article
- MeSH:
Aged;
Case-Control Studies;
Clopidogrel/therapeutic use*;
Hip Fractures/surgery*;
Humans;
Platelet Aggregation Inhibitors/adverse effects*;
Retrospective Studies;
Ticlopidine/adverse effects*
- From:
Chinese Medical Journal
2021;134(14):1720-1725
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.
METHODS:Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued <5 days before surgery constituted the clopidogrel group. The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex, fracture type, operative procedure, and time from injury to operation (±10 h). The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement, complications, and mortality. The Student's t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.
RESULTS:Age, body mass index, American Society of Anesthesiologists score, and percentage undergoing general anesthesia were comparable between the groups (P > 0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P < 0.001) and cerebrovascular disease (45.0% vs. 15.0%; P < 0.010) were significantly higher in the clopidogrel vs. control groups, respectively. The median clopidogrel discontinuation time before operation was 73.0 (range: 3.0-120.0) h. There was no significant difference in the estimated perioperative blood loss between the clopidogrel group (median: 745 mL) and control group (median: 772 mL) (P = 0.866). The intra-operative transfusion rate was higher in the clopidogrel group (22/60, 36.7%) than that in the control group (12/60, 20.0%) (P < 0.050). However, there was no significant difference in the blood transfusion rate during the entire perioperative period (26/60, 43.3% vs. 20/60, 33.3%; clopidogrel group vs. control group, respectively; P > 0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups.
CONCLUSIONS:Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.
