Related Experiment Video
Updated: Apr 6, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy
Sinan Zehir1, Regayip Zehir2, Taner Sarak3
1Hitit University Faculty of Medicine, Department of Orthopedics and Traumatology, Çorum, Turkey. sinanzehir@yahoo.com.
Insights
Early surgery for hip fractures is recommended for patients on clopidogrel. Delaying surgery increases hospital stay, complications, and mortality rates in these patients.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Cardiology
Background:
- Hip fractures are common in elderly patients.
- Antiplatelet agents like clopidogrel are frequently used, posing challenges for surgical timing.
- Optimal surgical timing for hip fracture patients on clopidogrel remains debated.
Purpose of the Study:
- To evaluate the outcomes of early versus delayed surgery in hip fracture patients using clopidogrel.
- To compare complication rates, hospital stay, and mortality between different surgical timing groups.
Main Methods:
- Retrospective analysis of 211 elderly patients with femoral neck fractures undergoing open surgery (2009-2014).
- Patients were divided into three groups: early surgery (<48h) with clopidogrel, delayed surgery (>5 days) with clopidogrel, and early surgery (<48h) without clopidogrel.
- Outcomes assessed included length of hospital stay, blood transfusion requirements, complication rates, and mortality.
Main Results:
- No significant differences in age, sex, preoperative hemoglobin, or ASA scores between groups.
- Early surgery (<48h) in clopidogrel users showed higher blood transfusion needs compared to non-users.
- Delayed surgery (>5 days) in clopidogrel users was associated with significantly longer hospital stays, higher complication rates, and increased 30-day and 3-month mortality.
Conclusions:
- Early surgical intervention is advisable for hip fracture patients on clopidogrel.
- Postponing surgery in this cohort is linked to adverse outcomes, including increased morbidity and mortality.
Objective:
Timing of surgery in hip fracture patients using antiplatelet agents is a controversial issue. Clopidogrel is an antiplatelet drug widely used in the treatment of many diseases. In this study, we aimed to investigate the outcomes of early surgery in hip fracture patients using clopidogrel.
Methods:
Elderly patients with femoral neck fractures who underwent open surgery between 2009 and 2014 were evaluated. Two hundred and eleven patients were included in the study. Patients were separated into 3 groups. Group 1 was constituted of patients using clopidogrel who had been operated on within 48 h after admission (n=74), Group 2 was constituted of patients using clopidogrel who had been operated on after the fifth day of admission (n=55), and Group 3 was constituted of patients not using clopidogrel who had been operated on within 48 h after admission (n=83). Length of hospital stay, amount of blood transfusion, rate of complication, and mortality rate were assessed for comparison of groups.
Results:
Age, sex, preoperative hemoglobin values, and ASA scores were not different between the groups. Amount of blood transfusions was higher in Group 1 (p=0.023). Duration of hospital stay was longer in Group 2 (p<0.01), as was complication rate (25.4%) (p<0.01). Mortality within 30 days and within the first 3 months post-surgery was significantly higher in Group 2 (p=0.031, p<0.01; respectively).
Conclusion:
Surgery should not be postponed in hip fracture patients using clopidogrel.
