ABSTRACT
Objective:
To investigate the
safety of early
hip fracture
surgery for
elderly patients on
clopidogrel.
Methods:
This
retrospective study included 242 consecutive
elderly patients (≥65 years) with acute
hip fracture
who had undergone
surgery at Department of Orthopaedic
Trauma,
Beijing Jishuitan
Hospital between November 2016 and April 2017. Of them, 20 were assigned into the study group
who had taken
clopidogrel before
injury but discontinued its use within 4 days before
surgery. They were 6
males and 14
females, with a median age of 80 years (77, 81). Their operation
procedures for
hip fracture included internal fixation with cannulated screws for
femoral neck fracture in 2 cases,
hemiarthroplasty for displaced
femoral neck fracture in 11 cases, and internal fixation for intertrochanteric fracture in 7 cases. The
control group included 222
patients who had undergone the same
operative procedures but not taken any antiplatelet or
anticoagulant drugs. The 2 groups were compared in terms of
time between admission and operation, operation duration, intraoperative
blood loss, perioperative transfusion and
complications related to
bleeding to analyze the
safety of early
surgery.
Results:
There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference between the 2 groups in the
time between admission and operation [42.5 (36.3, 48.0) h for the study group versus 43.0 (28.0, 61.0) h for the
control group] ( P=0.870). The median
time between the last use of
clopidogrel and operation was 55.0 (30.5, 71.0) h. There were no significant differences between the 2 groups in preoperative
hemoglobin, operation duration, intraoperative
blood loss, rate or amount of perioperative
blood transfusion, or rate or amount of
wound drainage ( P>0.05). The rate of
general anesthesia was significantly higher for the study group (45.0%, 9/20) than for the
control group (18.5%,41/222) ( P=0.012). No
complications related to spinal
hematoma occurred in the
patients receiving
spinal anesthesia from the study group.
Wound hematoma and subsequent
infection occurred in 2
patients from the
control group.
Conclusion:
Early
hip fracture
surgery is safe for
elderly patients on
clopidogrel.