PATIENTS ADMITTED WITH A HIP FRACTURE TAKING ANTITHROMBOTIC MEDICATION

Abstract

Patients who sustain hip fractures should be operated on within 24 hours of admission according to the Royal College Of Physician Guidelines. A delay to theatre of more than 4 days is associated with an increase in inpatient mortality. A high proportion of patients with hip fractures are elderly and take aspirin, clopidogrel or warfarin.

A retrospective review of 100 patients admitted between December 2006 and July 2007 with a hip fracture was conducted. Our aims were to assess the proportion of patients taking antithrombotic medication, when the antithrombotic medication was stopped pre-operatively and see whether there was a delay to theatre. We also evaluated any association between patients taking antithrombotic medication and a return to theatre, post-operative morbidity and mortality and length of inpatient stay.

47 patients were taking aspirin, 1 was taking clopidogrel, 2 were on aspirin and clopidogrel and 3 patients were taking warfarin. The aspirin group had an increased delay to theatre compared to the no antithrombotic group, however, both groups had similar numbers operated on within 24 hours. 68% (32/47) patients had the aspirin stopped on the same day as the operation. 1 patient taking aspirin returned to theatre for evacuation of a haematoma. The main post-operative complication was pneumonia (n=9). 8 patients required a blood transfusion of which 5 were taking aspirin. The main causes of mortality were ischaemic heart disease (n=7) and pneumonia (n=5). The mean lengths of inpatient stay were 22.48 days in the aspirin group, 50 days in the aspirin and clopidogrel group, 66 days in the clopidogrel group, 24.33 in the warfarin group and 24.81 days in the no antithrombotic group.

It is suggested from this small study that there is no advantage in stopping aspirin prior to hip fracture surgery. However, further studies need to be undertaken.