Is discontinuation of clopidogrel necessary for intracapsular hip fracture surgery? Analysis of 102 hemiarthroplasties

被引：30
作者：
Hossain F.S. [1 ,2 ]
Rambani R. [3 ]
Ribee H. [4 ]
Koch L. [4 ]
机构：
[1] North Lincolnshire and Goole Hospitals NHS Foundation Trust, Grimsby
[2] Hull HU2 8JR
[3] Leeds Teaching Hospitals NHS Trust, Leeds
[4] Mid Yorkshire Hospitals NHS Trust, Dewsbury
来源：
Journal of Orthopaedics and Traumatology | 2013年 / 14卷 / 3期
关键词：
Clopidogrel; Complications; Hip fracture; Transfusion;
D O I：
10.1007/s10195-013-0235-1
中图分类号：
学科分类号：
摘要：
Background: An increasing number of elderly patients are managed with long-term antiplatelet therapy. Such patients often present with hip fracture requiring surgical intervention and may be at increased risk of perioperative bleeding and complications. The aim of this study was to ascertain whether it is necessary to stop clopidogrel preoperatively to avoid postoperative complications following hip hemiarthroplasty surgery in patients with intracapsular hip fracture. Materials and methods: A retrospective review of 102 patients with intracapsular hip fracture with either perioperative clopidogrel therapy [clopidogrel group (CG)] or no previous clopidogrel exposure [no clopidogrel group (NCG)] who underwent hip hemiarthroplasty surgery was undertaken. Statistical comparison on pre- and postoperative haemoglobin, American Society of Anesthesiologists (ASA) grade, comorbidities, operative time, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rate between the two groups was undertaken. Regression analysis was undertaken to ascertain the risk ratios (RR) of complications and transfusion associated with clopidogrel. Results: There was no difference with respect to ASA grade, comorbidities (except cardiac comorbidities), preand postoperative haemoglobin levels, operation time, age or gender between the two groups. Four and two patients, respectively, required transfusion postoperatively in the CG and NCG (p = 0.37). There was no difference with respect to LOS, wound infection, haematoma or reoperation rate between the two groups postoperatively. The covariateadjusted RR for complications and transfusion while being on clopidogrel were 0.43 [95 % confidence interval (CI) 0.07-2.60] and 3.96 (95 % CI 0.40-39.68), respectively. Conclusion Continuing clopidogrel therapy throughout the perioperative period in patients with intracapsular hip fracture is not associated with an increased risk of complications following hip hemiarthroplasty surgery. © The Author(s) 2013.
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页码：171 / 177
页数：6
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