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Clopidogrel therapy--implications for hip fracture surgery.

Antony Johansen¹, James White, Adrian Turk

¹Trauma Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK. antony.johansen@cardiffandvale.wales.nhs.uk

|July 29, 2008

Summary

Delaying hip fracture surgery for patients on clopidogrel may reduce blood loss but could increase risks of thromboembolic complications. An individualized approach is recommended for managing these patients.

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Area of Science:

Orthopedic Surgery
Cardiology
Pharmacology

Background:

Clopidogrel is an anti-platelet medication increasingly used in patients with cardiovascular conditions.
Hip fracture surgery is common in elderly patients, many of whom may be on clopidogrel therapy.
The optimal management of hip fracture in patients taking clopidogrel remains unclear.

Purpose of the Study:

To investigate the implications of clopidogrel therapy on peri-operative blood loss and complications in hip fracture patients.
To evaluate the outcomes of delaying hip fracture surgery in patients taking clopidogrel.

Main Methods:

Retrospective follow-up of 740 consecutive hip fracture admissions.
Analysis of blood loss (hemoglobin fall) and complications in 17 patients on clopidogrel.
Comparison of outcomes between patients with delayed surgery (≥5 days) and those without delay.

Main Results:

A peri-operative fall in hemoglobin was 1.3g/dl less in patients whose surgery was delayed by at least 5 days (10 patients).
The group with delayed surgery experienced potentially attributable thromboembolic complications.
Clopidogrel therapy impacts peri-operative blood loss in hip fracture patients.

Conclusions:

Clopidogrel therapy has implications for peri-operative blood loss in hip fracture surgery.
Delaying surgery may reduce blood loss but carries a risk of thromboembolic complications.
An individualized approach is recommended for managing hip fracture patients on clopidogrel therapy.