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Evaluation of Clopidogrel Safety in Geriatric Patients with Hip Fracture: A Retrospective Study
Yuanfang Zheng1, Yan Zhou1, Minghui Yang2
1Anesthesiology Department, Beijing Jishuitan Hospital, Beijing, China.
Insights
Elderly patients with hip fractures on clopidogrel can safely undergo surgery within 5-7 days of stopping the anti-platelet medication. This study found no significant increase in bleeding risk for these patients.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Cardiology
Background:
- Hip fractures are common in elderly patients, often requiring surgical intervention.
- Anti-platelet medications like clopidogrel are frequently used in this population for cardiovascular protection.
- Early surgery for hip fractures is often preferred, but concerns exist regarding bleeding risk in patients on clopidogrel.
Purpose of the Study:
- To evaluate the bleeding risk associated with early hip fracture surgery in elderly patients who are taking clopidogrel.
- To compare outcomes between patients undergoing surgery with and without recent clopidogrel administration.
Main Methods:
- Retrospective study of patients over 65 years with hip fractures.
- Patients taking clopidogrel underwent surgery without a 5-7 day waiting period.
- Comparison of bleeding outcomes (intraoperative blood loss, transfusion rates) and secondary outcomes (operation duration, hospital stay) between clopidogrel and control groups, stratified by fracture type and surgical method.
Main Results:
- No statistically significant differences in baseline characteristics or key outcomes (blood loss, transfusion rates, operation duration, hospital stay) were observed between groups.
- A higher percentage of patients in the clopidogrel group received general anesthesia (P=0.01).
- Specific surgical methods like internal fixation of femoral neck fractures showed lower blood loss, while total hip arthroplasty, associated with higher bleeding risk, was rarely used.
Conclusions:
- Early hip fracture surgery (within 5-7 days of clopidogrel discontinuation) appears relatively safe for elderly patients.
- The findings support current practices of not delaying surgery significantly for patients on long-term clopidogrel therapy.
- Further research could explore anesthesia choices and specific surgical techniques to optimize outcomes.
Objective:
To evaluate the risk of bleeding in elderly patients undergoing early hip fracture surgery with/without clopidogrel administration.
Methods:
This was a retrospective study, and patients over 65 years with fresh hip fracture were enrolled. For the patients taking clopidogrel, early surgical treatment was performed without 5-7 days waiting time. The patients were divided into groups according to their fracture type and the surgical method. Within each fracture/surgery group, the patients were further divided into subgroups according to whether they had clopidogrel administration. The patients' age, gender, American Society of Anesthesiologists (ASA) score, hemoglobin level at admission, and the time from admission to surgery were compared in the different groups. The bleeding outcomes, such as intraoperative blood loss and blood transfusion status, as well as secondary outcomes, such as operation duration and length of hospital stay, were also compared in these groups.
Results:
There were no statistically significant differences in patients' baseline characteristics and outcomes, including intraoperative blood loss, blood transfusion rate, operation duration and length of hospital stay, between the clopidogrel-administrated patients and the control patients. However, the percentage of patients taking general anesthesia was significantly higher in clopidogrel group than that in control group (P = 0.01). Similar intraoperative blood loss was found in the subgroups of hemi-hip replacement, internal fixation for intertrochanteric fracture of the femur (fracture type A1-2, short pin), and internal fixation of femoral neck fracture with cannulated nails. For the internal fixation of femoral neck fracture with cannulated nails, the blood loss is significantly less in both subgroups than that with other two surgical methods. Moreover, the total hip arthroplasty, with the highest bleeding risk among all the surgical methods involved, was rarely chosen to treat geriatric hip fracture in this study.
Conclusion:
This study indicated that compared with patients without clopidogrel administration, elderly patients with hip fractures who receive clopidogrel as long-term anti-platelet therapy are relatively safe for surgery in less than 5-7 days after discontinuation of clopidogrel.
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