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[Hip fracture, antiplatelet drugs treatment and postoperative complications]
1Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España.
Insights
Delaying hip fracture surgery for elderly patients on antiplatelet drugs, particularly clopidogrel, may increase respiratory and cardiovascular complications. This study assessed postoperative outcomes in patients on various antiplatelet treatments.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Orthopedic Surgery
Context:
- Hip fractures are common in the elderly, often requiring surgical intervention.
- Elderly patients frequently have comorbidities and are often on antiplatelet medications for cardiovascular protection.
- The management of antiplatelet therapy around surgery poses a risk-benefit dilemma.
Purpose:
- To evaluate the incidence of postoperative complications, need for blood transfusions, and one-month survival in elderly patients undergoing hip fracture surgery while on chronic antiplatelet therapy.
- To compare outcomes among different classes and dosages of antiplatelet agents (aspirin, triflusal, thienopyridines) and the impact of surgical delay.
Summary:
- A retrospective study of 223 hip fracture patients categorized them by antiplatelet regimen: Group I (aspirin), Group II (low-dose aspirin/triflusal), and Group III (high-dose aspirin/triflusal or thienopyridines). Surgery was delayed by 4 days for Group III patients.
- Group III patients were older with poorer health. While Group II had higher transfusion needs, Group III experienced significantly more respiratory complications (P=0.007) and severe cardiovascular events (5.4%).
- Delaying surgery in Group III (thienopyridines) was associated with increased respiratory complications and severe cardiovascular events, but not increased transfusion index, hospital stay, mortality, or neuraxial anesthesia complications.
Impact:
- Findings suggest that a 4-day surgical delay for elderly hip fracture patients on thienopyridines (like clopidogrel) may increase postoperative respiratory and cardiovascular risks.
- This highlights the importance of carefully considering the timing of surgery in relation to antiplatelet therapy to optimize patient outcomes.
- The study provides evidence to inform clinical decision-making regarding perioperative management of antiplatelet agents in this vulnerable population.
Objectives:
To assess the incidence of postoperative complications, blood transfusions and survival at one month, in the old patients operated for hip fracture undergoing chronic treatment with antiplatelet drugs.
Material And Methods:
Two hundred twenty three patients operated for hip fracture were studied retrospectively, separated into 3 groups: patients who received acetylsalicylic acid (group I), patients who were given 100mg/day of acetylsalicylic acid or 300mg/day of triflusal (group II) and patients receiving>100mg/day of acetylsalicylic acid, or>300mg/day of triflusal or thienopyridines (group III). Surgery was delayed for 4 days in patients in group III. Demographic, biological, clinical and treatment characteristics, postoperative complications and survival at one month were recorded.
Results:
Patients in group III were older and sustain worse general health status. Patients with a higher transfusion requirement were those of group II (73.8%) (P=0.192), who also showed a higher percentage of anaemia on admission. Severe cardiovascular complications were experienced by 5.4% of group III patients, 4.8% of group II patients and 2.1% of group I patients. Patients from group III presented a significant amount of respiratory complications (P=0.007).
Conclusions:
Our results suggest that delaying surgery for 4 days in patients treated with clopidogrel can be associated to an increase in postoperative respiratory complications and severe adverse cardiovascular events, without increasing the tranfusional index, hospital stay, mortality, and without complications related to neuraxial anaesthesia.
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