Abstract
Introduction
Increasing numbers of elderly patients are being prescribed Clopidogrel, an anti-platelet agent for medical reasons. There are no international guidelines as to the management of patients with hip fractures on Clopidogrel in peri-operative period especially in relation to timing of the surgery. In Waterford Regional Hospital in Ireland, hip fracture surgery is deferred for 4 days and platelets are reserved for the operative/post-operative period, in case they have significant bleeding or an associated complication. We conducted a retrospective study on patients admitted over a period of 1 year.
Materials and methods
A retrospective review of case notes was performed on all the hip fractures on Clopidogrel that had been admitted over last 1 year. Age, Sex, ASA, number of cancellations, operation performed, length of stay, post-op complications including wound, blood & platelet transfusions data were recorded.
Results
Over this period, we admitted 53 patients who sustained hip fractures who were on plavix. The mean age was 80.6 years and the male:female ratio was 25:28. The mean length of stay was 23.4 days (range 3 to 63 days). There was an average delay of 5.37 days between admission and surgery (range 1 to 11 days). An average drop of 1.16 gm between pre-operative and post-operative hemoglobin was noted (range 8.7 gm to 15.7 gm pre-operatively and 7.3 gm to 15 gm post-operatively). There were no wound hematomas or prolonged wound oozes. Only 2 of those patients needed platelet transfusions intra-operatively. The RCC transfusion rate was 0.86 units of blood/per patient.
Conclusion
The policy of delaying surgery for 4 days needs to be questioned. There were no incidences of bleeding or hematoma formation in all of our patients. The ideal time to operate on hip fracture patients is within 24–48 hours of admission after medical optimisation.
