Clopidogrel and Proximal Femoral Fractures: Does Timing of Surgery Affect Blood Loss and Length of Admission? A Preliminary Study Prior to Multicenter Trial

Abstract

Introduction: Clopidogrel is a potent oral antiplatelet agent that is commonly prescribed to patients with cardiovascular disease. Patients presenting with proximal femoral fractures often have cardiovascular comorbidity, with many taking clopidogrel on admission. Scientific literature reports increased surgical bleeding in patients receiving clopidogrel, though not specifically hip surgery. This study looked at whether patients who had a seven-day delay prior to operative treatment had less bleeding than those who did not, and looked at the differences in length of admission between the two groups.

Methods: A retrospective review was undertaken. Patients were identified from the in-patient pharmacy stock records from July 2005 to July 2006. Data was statistically analyzed using the chi-squared test.

Results: Of 21 patients identified, 20 met the inclusion criteria, nine had a seven-day delay before operation (Group A), and 11 had a mean one-day delay (Group B). Mean drop in postoperative hemoglobin was 1.8 g/l in Group A compared to 3.1 g/l in Group B (p < 0.05). Number of complications was similar (Group A = 8 vs. Group B = 9) as was mortality (Group A = 1 vs. Group B = 2). Admission length was longer in patients who had a seven-day delay in surgery (Group A = 32 vs. Group B = 22 days) (p < 0.05).

Conclusion: Patients should be considered for early operation provided there are no additional bleeding risk factors, as although postoperative hemoglobin is lower, mortality and complication rates are similar, and length of admission is shorter.

Keywords: Bleeding; Blood; Clopidogrel; Femur; Fracture; Hip; Neck; Plavix.