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

Background: Early surgical treatment is indicated to reduce mortality and morbidity associated with immobilization due to hip fracture. The judiciousness of postponing surgery to allow withdrawal of clopidogrel and return of normal platelet function (5-10 days) in elderly patients being chronically treated with this antiplatelet medication is a matter of ongoing controversy. Objective: The purpose of this study was to compare the morbidity and mortality rates in elderly patients receiving long-term treatment with clopidogrel who were operated on with or without delay (due to withdrawal of clopidogrel) following a hip fracture. Methods: We compared relevant demographic and medical/surgical parameters in patients receiving long-term treatment with clopidogrel who sustained a hip fracture and underwent either early (n=30, mean +/- SD age 81.6 +/- 8.7 years, 17 males [57%]) or delayed (n=30, mean SD +/- age 83.3 +/- 7.1 years, 13 males [43%]) surgical intervention between May 2007 and February 2010. Results: Both groups were similar with regard to sex, age, co-morbidities and fracture type. The mortality rate was similar in both groups. Patients in the delayed treatment group had more complications associated with prolonged immobilization (pulmonary embolism, pulmonary oedema, decubitus ulcer). Time from admission to surgery and hospitalization stay were significantly longer in the delayed treatment group than in the early treatment group (mean +/- SD 7 days and 12 hours +/- 2 days and 17 hours compared with 1 day and 16 hours +/- 1 day [p < 0.0001] and 17 days and 17 hours +/- 7 days and 5 hours versus 11 days and 2 hours +/- 4 days and 19 hours [p=0.0002], respectively). Conclusions: Early surgical intervention for hip fracture in patients receiving long-term treatment with clopidogrel appears to be safe in terms of bleeding complications. It has the potential to enable earlier mobilization and shorter hospitalization and may reduce mortality and complications associated with immobilization.