In Support of Early Surgery for Hip Fractures Sustained by Elderly Patients Taking Clopidogrel

Chechik, Ofir; Amar, Eyal; Khashan, Morsi; Kadar, Assaf; Rosenblatt, Yishai; Maman, Eran

doi:10.2165/11598490-000000000-00000

Cited by 36 publications

(33 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty-one studies deemed to be relevant to the research question underwent full text review. Studies were excluded for the following reasons: Japanese language (1) [35]; paper was unavailable for review (1) [33]; clopidogrel group had a mean time to surgery of >7 days and was therefore felt to be non-comparable (2) [38,39]; letters (3) [36,40,41]; no comparison group (2) [42,43]; no relevant data (1) [34]; abstract only (1) [44]; surveys (3) [22,23,24]; no clopidogrel group (1) [45]; included patients on other antiplatelets (1) [32,46] and early surgery >48 h (2) [47,48] This left 12 studies, which were included in the review [30,31,[49][50][51][52][53][54][55][56][57][58].…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…On meta-regression, neither mean age (p = 0.268) nor percentage female (p = 0.963) could predict differences in mortality. Three studies [31,55,58] reported mortality outcomes in early versus delayed surgery. Overall, the odds ratio for mortality was 0.61 (95% CI: 0.11-3.25).…”

Section: Studymentioning

confidence: 99%

“…Two studies [55,58] reported the proportion of patients transfused in the early versus delayed surgery group. The odds ratio was non-significant at 0.44 (95% CI: 0.15-1.30).…”

Section: Blood Transfusionmentioning

confidence: 99%

See 2 more Smart Citations

Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

Doleman

Moppett

2015

Injury

View full text Add to dashboard Cite

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

See 1 more Smart Citation

Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

Doleman

Moppett

2015

Injury

View full text Add to dashboard Cite

“…In another paper, Chechik et al compared 30 patients who were on clopidogrel and underwent early surgery (mean time: 1 day and 16 hours, SD: 1 day) with a group of patients who underwent delayed surgery (mean time: 7 days and 12 hours, SD: 2 days and 17 hours). 19 They found that the early treatment group had a shorter hospital stay than the delayed group (11 vs 17 days, p=0.0002). Even though the mortality rates were similar, there were more complications related to prolonged immobilisation in the delayed treatment group.…”

Section: Discussionmentioning

confidence: 95%

“…3,4 There is a paucity of literature reporting the risks and benefits of operating on these patients. 5,6 This study sought to determine whether time to surgery influenced factors including drop in haemoglobin (Hb) levels, need for blood transfusion, duration of inpatient stay and 30-day mortality for patients who were admitted with a neck of femur fracture while taking clopidogrel. …”

mentioning

confidence: 99%

Decision making on timing of surgery for hip fracture patients on clopidogrel

Purushothaman

Webb

Weusten

et al. 2016

annals

View full text Add to dashboard Cite

Patients taking clopidogrel who sustain a fractured neck of femur pose a challenge to orthopaedic surgeons. The aim of this study was to determine whether delay to theatre for these patients affects drop in haemoglobin levels, need for blood transfusion, length of hospital stay and 30-day mortality. A retrospective review of all neck of femur patients admitted at two centres in the North East of England over 3 years revealed 85 patients.Patients were divided into two groups depending on whether they were taking clopidogrel alone (C) or with aspirin (CA). Haemoglobin drop was significantly different in the CA group that was operated on early (CA1) versus the group for which surgery was delayed by over 48 hours (CA2): 3.3g/dl and 1.9g/dl respectively (p=0.01). The mean inpatient stay in group C was 35.9 days while in group CA it was 19.9 days (p=0.002). The mean length of stay in group CA2 (26.7 days) was significantly longer than for CA1 patients (14.1 days) (p=0.01). There were no significant differences in mortality or wound complications.Hip fracture patients on clopidogrel can be safely operated on early provided they are medically stable. Bleeding risk should be borne in mind in those patients on dual therapy with aspirin. KEYWORDSHip fracture -Clopidogrel -Aspirin -Delay to surgery Clopidogrel is a thienopyridine that irreversibly binds to platelets inhibiting aggregation. It is used commonly with or without aspirin for primary and secondary prevention of cardio and cerebrovascular disease. Given the prevalence of coronary disease, advances in coronary intervention for stable and unstable cardiac as well as stroke disease, it is no surprise that the number of patients admitted to hospital on dual antiplatelet therapy (DAPT) as well as other newer anticoagulant agents is rising. The timing of operative intervention for hip fracture patients on antiplatelet agents poses a significant challenge to the multidisciplinary team managing these complex patients. Hip fracture patients tend to be older with co-morbidities. There is consensus in the orthopaedic community that if feasible and indicated, surgery should be carried out at the earliest opportunity followed by early mobilisation. Patients taking DAPT, clopidogrel alone or other anticoagulants have an elevated bleeding risk in the perioperative period. These patients have a higher risk of bleeding if operated on early while delaying surgery is associated with increased risk of morbidity and mortality. There is a lack of consensus among orthopaedic teams for timing of operation, with some surgeons choosing to stop their patients' antiplatelet treatment and delay operative management. 3,4 There is a paucity of literature reporting the risks and benefits of operating on these patients. 5,6 This study sought to determine whether time to surgery influenced factors including drop in haemoglobin (Hb) levels, need for blood transfusion, duration of inpatient stay and 30-day mortality for patients who were admitted with a neck of femur fracture while taking cl...

show abstract

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient-and systemlevel factors. OBJECTIVETo catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items forSystematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components.FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCEIn this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.

show abstract

In Support of Early Surgery for Hip Fractures Sustained by Elderly Patients Taking Clopidogrel

Cited by 36 publications

References 12 publications

Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression

Decision making on timing of surgery for hip fracture patients on clopidogrel

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

Contact Info

Product

Resources

About