Safety of early surgery for geriatric hip fracture patients taking clopidogrel:a retrospective case-control study of 120 patients in China

Background:Geriatric hip fracture patients receiving clopidogrel are a surgical challenge.In China,most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days.However,delayed surgery is associated with increased complications and mortality in the older adults.This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal.Methods:Acute hip fracture patients(≥65 years)who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed.Sixty patients taking clopidogrel before injury and discontinued<5 days before surgery constituted the clopidogrel group.The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex,fracture type,operative procedure,and time from injury to operation(±10 h).The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement,complications,and mortality.The Student’s t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables.Results:Age,body mass index,American Society of Anesthesiologists score,and percentage undergoing general anesthesia were comparable between the groups(P>0.050).The percentages of patients with coronary heart disease(61.7%vs.18.3%;P<0.001)and cerebrovascular disease(45.0%vs.15.0%;P<0.010)were significantly higher in the clopidogrel vs.control groups,respectively.The median clopidogrel discontinuation time before operation was 73.0(range:3.0–120.0)h.There was no significant difference in the estimated perioperative blood loss between the clopidogrel group(median:745 mL)and control group(median:772 mL)(P=0.866).The intra-operative transfusion rate was higher in the clopidogrel group(22/60,36.7%)than that in the control group(12/60,20.0%)(P<0.050).However,there was no significant difference in the blood transfusion rate during the entire perioperative period(26/60,43.3%vs.20/60,33.3%;clopidogrel group vs.control group,respectively;P>0.050).There was no significant difference in perioperative complications,and 30-day and 1-year mortality rates between the groups.Conclusions:Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal,without increased perioperative blood loss,transfusion requirement,complications,and mortality compared with patients not taking antiplatelet drugs.