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

Doleman, Brett; Moppett, I. K.

doi:10.1016/j.injury.2015.03.024

Cited by 55 publications

(37 citation statements)

References 66 publications

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“…In addition, the studies found early surgery to be safe with no increase in mortality. Doleman and Moppett in their earlier meta-analysis reported similar findings [14].…”

Section: Clopidogrelmentioning

confidence: 63%

Implications of anticoagulant and antiplatelet therapy in patients presenting with hip fractures: a current concepts review

et al. 2018

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The increasing use of anticoagulant and antiplatelet therapy for the prevention of thromboembolic disease poses a significant challenge to orthopaedic surgeons treating elderly patients presenting with proximal femoral fractures. Early surgical intervention is known to be beneficial from a clinical perspective and has been encouraged in the UK through the introduction of best practice tariffs providing increased remuneration for prompt treatment. An understanding of the necessary delay to surgery or reversal options for each type of antiplatelet or anticoagulant agent is therefore important. A number of professional bodies have recently produced guidelines that help clinicians manage these patients during the peri-operative period. We review the guidelines relating to antiplatelet and anticoagulant agents during the perioperative period with respect to hip fracture surgery. Antiplatelet agents should not interfere with timing of surgery, but may affect the choice of anaesthetic performed. The action of warfarin should be reversed to expedite surgery. Newer direct oral anticoagulants are more problematic and surgical delay may be necessary, though reversal agents are becoming available.

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“…In addition, the studies found early surgery to be safe with no increase in mortality. Doleman and Moppett in their earlier meta-analysis reported similar findings [14].…”

Section: Clopidogrelmentioning

confidence: 63%

Implications of anticoagulant and antiplatelet therapy in patients presenting with hip fractures: a current concepts review

et al. 2018

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“…Among them, 20.9% of the surgeries were delayed by more than 5 days, and 12.7% were delayed by 7-10 days. [18] Although Soo et al [19] and Doleman et al [20] tried to identify how to manage these cases, the total numbers of studies included in these reviews were low, and these studies may result in type II errors and were either limited to one specific antiplatelet drug or confused the presence or absence of antiplatelet drugs with early or delayed surgery. Thus, we performed a more systematic and specific search and analysis to address the issues highlighted from previous research.…”

Section: Discussionmentioning

confidence: 99%

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

Yang

Long

et al. 2020

Preprint

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Background: Hip fractures are common and account for a large proportion of orthopaedic surgical admissions in elderly patients. However, determining the timing for surgery has been controversial for patients who develop with hip fractures while on antiplatelet treatment. Methods: Computerized databases for studies published from the inception date to January 2020, including the Cochrane Library, PubMed (Medline), EMBASE, Web of Science TM , ClinicalTrials, ClinicalKey and Google Scholar, were searched using the keywords “Hip AND Fracture”, “Antiplatelet”, “Antithrombocyte”, “Platelet aggregation inhibitors”, “Aspirin”, “Plavix”, and “Clopidogrel”. Results: In total, 2328 initial articles were identified. Twenty-four studies with 5423 participants were ultimately included in our analysis. Early surgery was associated with an increased transfusion rate in the antiplatelet group compared to the non-antiplatelet group (OR = 1.21; 95% CI, 1.01 to 1.44; p = 0.03). Early surgery for hip fracture patients on antiplatelet therapy was associated with a greater decrease in haemoglobin compared to delayed surgery (WMD = 0.75; 95% CI, 0.50 to 1.00; p < 0.001). However, early surgery appeared to decrease the length of hospitalization (WMD = -6.05; 95% CI, -7.06 to -5.04; p < 0.001) and mortality (OR = 0.43; 95% CI, 0.23 to 0.79; p = 0.006). Conclusion: It is unnecessary to delay surgery to restore platelet function when patients with hip fractures receive antiplatelet therapy. Furthermore, early surgery can significantly reduce mortality and hospital stay, which is conducive to patient recovery. Future randomized trials should determine whether the results are sustained over time.

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“…Odds ratio for transfusion was 1.24 (95% confidence interval 0.91 to 1.71), not statistically significant (p=0.14). The authors conclude that clopidogrel, if possible, should not be withheld throughout the perioperative period due to increased risk of cardiovascular events associated with stopping clopidogrel.Doleman et al [10] compared results from patients undergoing early surgery on clopidogrel to a control group not taking clopidogrel. In patients in clopidogrel undergoing early surgery in hospital and 30-day mortality were not significantly increased (OR 1.10 95% CI: 0.48-2.54) although the need for blood transfusion significantly higher than in control group (OR 1.41 95% CI: 1.00-1.99).…”

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

Cited by 55 publications

References 66 publications

Implications of anticoagulant and antiplatelet therapy in patients presenting with hip fractures: a current concepts review

Implications of anticoagulant and antiplatelet therapy in patients presenting with hip fractures: a current concepts review

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

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

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