Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy

Abstract

Surgery should not be postponed in hip fracture patients using clopidogrel.

Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A Systematic Review and Meta-analysis

“…Subgroup analysis showed that the combination of aspirin and clopidogrel may result in an increase in the mean number of units for transfusion (WMD = 0.69; 95% CI, 0.10-1.28; p = 0.02). Sensitivity analysis was performed by excluding Zehir et al [14], which was the primary source of statistical heterogeneity. This may be because in this study, the preoperative haemoglobin levels of the antiplatelet group were significantly lower than that of the control group.…”

“…There was remarkable statistical heterogeneity (p = 0.01; I 2 = 72%) and possible publication bias for the mean number of units for transfusion. Sensitivity analysis was performed by separately excluding Zehir et al [14], and the results remained unchanged.…”

“…As expected, the intervention groups in most studies [13,[21][22][23][24][25][26] showed a significant increase in the number of cardiovascular or cerebrovascular comorbidities; however, surprisingly, only three of them showed a significant difference in the ASA grade. [13,23,25] Moreover, the preoperative haemoglobin values of the intervention group in five studies [14,25,27,28] were significantly lower than those of the control group, which may potentially influence blood transfusions, meaning that the intervention groups required more units of blood. This may be why Zehir et al [14] was the main source of heterogeneity in the outcomes for the mean number of units for transfusion.…”

“…[13,23,25] Moreover, the preoperative haemoglobin values of the intervention group in five studies [14,25,27,28] were significantly lower than those of the control group, which may potentially influence blood transfusions, meaning that the intervention groups required more units of blood. This may be why Zehir et al [14] was the main source of heterogeneity in the outcomes for the mean number of units for transfusion. A further limitation was that publication bias existed in some studies as shown in the funnel plots; this might because the number of included trials was less than 10.…”

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

“…Although none of the end points differ between the two groups the author reported a different timing of bleeding. In the delayed surgery group it was noticed before surgery while it occurred in treatment with clopidogrel and the intervention may be performed general anesthesia (except if contraindicated) in the first 48 hours after trauma [12][13][14]. In patients in whom surgery must be postponed since they require medical stabilization the withdrawal of clopidogrel is questionable and justified only in order to perform neuraxial anesthesia.…”