A retrospective comparison between delayed and early hip fracture surgery in patients taking clopidogrel: same total bleeding but different timing of blood transfusion

Pailleret, Claire; Hamou, Zakaria Ait; Rosencher, Nadia; Samama, Charles‐Marc; Eyraud, Violaine; Chilot, François; Baillard, Christophe

doi:10.1007/s00264-017-3571-6

Cited by 22 publications

(18 citation statements)

References 24 publications

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“…In our clinic, neuraxial anesthesia is the preferred technique and a previous survival analysis found similar survival to reports using general anesthesia [2]. This may be an important factor for the longer time to surgery in our patients on antithrombotic medication compared to what is generally reported in the literature [10][11][12][13][14][15][16][17][18][19][20][21]. However, new evidence suggests mostly economic but no clinical benefit in hip fracture surgery under 24 h from hospital admission [7,23].…”

Section: Discussionsupporting

confidence: 58%

“…A study by Pean et al showed a wide variability among orthopedic surgeons regarding management of patients with hip fracture on clopidogrel [10]. Over a quarter of surgeons continued to opt for surgery postponement even though there appears to be no difference in total blood loss, transfusion rate, or 1-year mortality among patients receiving platelet aggregation inhibitor medication [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

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Platelet Aggregation Inhibitors and Anticoagulants Delay Surgery for Hip Fractures

et al. 2020

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Background: we aimed to analyze the influence of antithrombotic medication in delaying surgery for fragility hip fractures; Method: a total of 312 consecutive hip fracture cases over 55 years who underwent surgery in our Orthopedic Clinic; Results: of these, 90 patients received chronic antithrombotic medication. There were no differences between the medicated group and controls (n = 222) regarding age, gender, type of fracture and haemoglobin at admittance. However, median time to surgery was significantly longer in the medicated group: 4(3–6) days compared to 2(1–4) (p < 0.0001). By type of medication, time to surgery was: 3(1–4) days for acetylsalicylic acid (n = 44), 6(5.25–7.75) days for clopidogrel (n = 15), 4.5(4–7) days for acenocoumarin (n = 18) and 5(4–7.25) days for novel direct oral anticoagulants (n = 13). The Charlson comorbidity index was significantly higher in the medicated group: 5 [4–5] versus 4 [3–5]. There were no differences in transfusions except for fresh frozen plasma, which was administered more in the medicated patients; Conclusions: the prevalence of platelet aggregation inhibitors and anticoagulant use among fragility hip fracture patients is high, with almost a third using some form of antithrombotic medication. This may significantly lengthen time to surgery.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Platelet Aggregation Inhibitors and Anticoagulants Delay Surgery for Hip Fractures

et al. 2020

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“…Two meta-analyses of case series with controls [769, 770], and one systematic review [771], found a similar risk of bleeding or transfusion volume in patients with hip fracture surgery on pre-injury clopidogrel, compared with those not taking the agent at the time of surgery performed within 48 h. The authors recommend usual protocols with early surgery in all patients, and although there may have been a small increase (5%) in the proportion of patients requiring transfusion [769], mortality was not increased [769]. Further studies documented the safety (no increase in mortality or complications) of early operation for hip fracture on patients taking clopidogrel [772, 773]. However, a higher drop in Hb is expected in those on dual APA therapy [773, 774].…”

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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“…In a retrospective study were included 39 patients with hip fracture treated with clopidogrel [8]. Total blood loss, amount of blood transfusion and rate of postoperative complications were compared between the period 2011 to 2013 in which patients underwent delayed surgery, five days or more after clopidogrel withdrawal, and the period from 2014 to 2016 in which patients underwent early surgery, within 48 hours of admission.…”

Section: Department Of Medical and Surgical Critical Area Universitymentioning

confidence: 99%

Management of On-going Antiplatelet Treatment in Elderly Patients with Hip Fracture

Rostagno¹

2018

J Perioper Med

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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

Cited by 22 publications

References 24 publications

Platelet Aggregation Inhibitors and Anticoagulants Delay Surgery for Hip Fractures

Platelet Aggregation Inhibitors and Anticoagulants Delay Surgery for Hip Fractures

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

Management of On-going Antiplatelet Treatment in Elderly Patients with Hip Fracture

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