Abstract
Introduction
Premature cessation of clopidogrel in certain patients with cardiac conditions is associated with an increased risk of recurrent coronary events. Such patients often present with proximal femoral fractures requiring surgical intervention. Our aim was to ascertain whether it is necessary to stop clopidogrel preoperatively to avoid postoperative complications following hip hemiarthroplasty surgery.
Methods
A retrospective review of 102 patients with ongoing clopidogrel therapy and patients not on clopidogrel who underwent hip hemiarthroplasty for an intracapsular proximal femoral fracture was undertaken. Statistical comparison on pre- and postoperative haemoglobin (Hb), ASA grades, comorbidities, operative times, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rates between the two groups was undertaken.
Results
There were 50 patients in the clopidogrel group (CG) and 52 in the non-clopidogrel group (NCG). The mean age was 83 years. There was no difference with respect to ASA grade, comorbidities (except cardiac comorbidities), age, gender and operation times between the two groups. The mean preoperative Hb was 12.5 g/dl and 12.6 g/dl respectively in the CG and NCG (p=0.72). The mean postoperative Hb was 10.8 g/dl and 11.1 g/dl respectively in the CG and NCG (p= 0.37). 4 and 2 patients respectively required transfusions postoperatively in the CG and NCG (p= 0.37). A total of 8 and 5 units were utilised in the CG and NCG groups respectively (p= 0.54). There was no difference with respect to LOS, wound infection, haematoma and reoperation rates between the two groups postoperatively.
Conclusion
Maintaining clopidogrel therapy throughout the perioperative period in high risk patients with intracapsular proximal femoral fractures is not associated with an increased risk of bleeding or complications following hip hemiarthroplasty surgery.
