Clopidogrel and hip fractures, is it safe? A systematic review and meta-analysis

BMC Musculoskeletal Disorders

Research Article

Paul K. Della Torre¹  Tristan J. Yolland²  Michael A. Shatwell³  Christopher G. K. M. Soo³ 

[1] Orthopaedic surgery department, Concord Repatriation General Hospital, Hospital Rd, 2139, Concord, NSW, Australia;Orthopaedic surgery department, John Hunter Hospital, Lookout Rd, 2305, New Lambton Heights, NSW, Australia;Orthopaedic surgery department, Port Macquarie Base Hospital, Wrights Rd, 2444, Port Macquarie, NSW, Australia;

关键词: Orthopaedics;    Clopidogrel;    Anticoagulant;    Surgical blood loss;    Hip fracture;   

DOI  :  10.1186/s12891-016-0988-9

 received in 2015-12-10, accepted in 2016-03-16,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundFemoral 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.MethodsAll 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 I2 statistic.ResultsA 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.ConclusionsOn 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 registrationThis systematic review and meta-analysis has been registered on Research Registry on July 16, 2015. The Review Registry Unique Identifying Number is: reviewregistry61.

【 授权许可】

CC BY   
© Soo et al. 2016