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

作　　者：Ming-Hui Yang Bo Li Dong-Chen Yao Yan Zhou Wen-Chao Zhang Geng Wang Ping Zhang Shi-Wen Zhu Xin-Bao Wu 

机构地区：[1]Department of Orthopedics and Traumatology,Beijing Jishuitan Hospital,Peking University Fourth School of Clinical Medicine,Beijing 100035,China [2]Department of Anesthesiology,Beijing Jishuitan Hospital,Peking University Fourth School of Clinical Medicine,Beijing 100035,China [3]Department of Geriatric Medicine,Beijing Jishuitan Hospital,Peking University Fourth School of Clinical Medicine,Beijing 100035,China

出　　处：《Chinese Medical Journal》2021年第14期1720-1725,共6页中华医学杂志（英文版）

基　　金：the Capital’s Funds for Health Improvement and Research(No.2018-1-2071);the National Natural Science Foundation of China(No.82072445).

摘　　要：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

关 键 词：Hip fracture CLOPIDOGREL Blood loss Blood transfusion COMPLICATION Mortality 

分 类 号：R683[医药卫生—骨科学] R969[医药卫生—外科学]