Related Experiment Video
Updated: Mar 23, 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
Clopidogrel and hip fractures, is it safe? A systematic review and meta-analysis
Christopher G K M Soo1, Paul K Della Torre2, Tristan J Yolland3
1Orthopaedic surgery department, Port Macquarie Base Hospital, Wrights Rd, Port Macquarie, NSW, 2444, Australia. gavin.soo@gmail.com.
Insights
Elderly patients with femoral neck fractures on clopidogrel can undergo early surgery without increased bleeding risk. Continuing clopidogrel perioperatively is recommended to prevent cardiovascular events, with intraoperative care to minimize blood loss.
Area of Science:
- Orthopaedic Surgery
- Geriatric Medicine
- Cardiology
Background:
- Femoral neck fractures are common in the elderly, posing surgical challenges for patients on clopidogrel due to bleeding risks.
- Optimal timing for surgery in these patients is difficult to determine.
- This systematic review aims to establish guidelines for managing hip fracture patients on clopidogrel.
Purpose of the Study:
- To systematically review existing evidence on managing elderly patients with femoral neck fractures who are taking clopidogrel.
- To establish guidelines for surgical timing and perioperative management in this patient group.
Main Methods:
- A systematic review of comparative studies (intervention vs. control groups).
- Data extraction included transfusion exposures, units transfused, hemoglobin levels, and hemoglobin drop.
- Pooled analysis using a fixed effects model, with heterogeneity assessed by the I² statistic.
Main Results:
- 14 case series with controls were included from 4219 identified studies.
- No significant heterogeneity was found among the studies.
- Pooled odds ratio for transfusion exposures was 1.24 (not statistically significant, p=0.14); no significant differences in other primary outcomes.
Conclusions:
- Early surgery for femoral neck fractures in elderly patients on clopidogrel is safe and does not significantly increase bleeding risk.
- Clopidogrel should ideally not be withheld perioperatively to avoid cardiovascular events.
- Careful intraoperative techniques to minimize blood loss are advised.
Background:
Femoral neck fractures in the elderly make up a large proportion of Orthopaedic surgical admissions each year. Operating on patients with clopidogrel poses a challenge because of the risk of bleeding and the difficulty deciding the optimal timing of surgery. The aim of this systematic review is to examine the published evidence to establish a set of guidelines for approaching neck of femur patients who are on clopidogrel.
Methods:
All comparative studies with an intervention group and a control group were considered. Data on patient blood transfusion exposures, units transfused, haemoglobin concentration and drop in haemoglobin were extracted and pooled using the fixed effects model. Heterogeneity of the intervention effect was assessed with the I (2) statistic.
Results:
A total of 4219 studies were identified. After removal of duplicates and after exclusion criteria were applied, there were 14 studies to be included. All 14 were case series with controls. There was no significant heterogeneity amongst the studies. Pooled odds ratio for transfusion exposures was 1.24 (95 % confidence interval 0.91 to 1.71) however this was not statistically significant (p = 0.14). No significant mean differences were found for other primary outcome measures.
Conclusions:
On the available evidence, we recommend that these patients can be managed by normal protocols with early surgery. Operating early on patients on clopidogrel is safe and does not appear to confer any clinically significant bleeding risk. As reported in other studies, we believe clopidogrel, if possible, should not be withheld throughout the perioperative period due to increased risk of cardiovascular events associated with stopping clopidogrel. Care should be taken intraoperatively to minimise blood loss due to the increased potential for bleeding.
Trial Registration:
This systematic review and meta-analysis has been registered on Research Registry on July 16, 2015. The Review Registry Unique Identifying Number is: reviewregistry61 .
