In the JournalsPerspective

Patients may safely continue antiplatelet medication during urgent hip fracture surgery

Patients who received antiplatelet medication and underwent urgent surgery for hip fractures were not significantly different than patients who did not receive antiplatelet medication with regard to total blood loss, transfusion or 1-year mortality rates, according to recently published results. Researchers said the findings may indicate that patients can undergo urgent hip fracture surgery without drug cessation.

Researchers identified 176 patients who were 55 years of age or older with uncomplications hip fractures and underwent surgery within 48 hours after admission. Based on the preoperative medication regimen, 29 patients received aspirin and dipyridamole combined; 63 patients received aspirin alone; 29 patients received dipyridamole alone; and 56 patients did not receive antiplatelet medication. Investigators assessed total blood loss, transfusion rate and 1-year mortality rate.

Results showed the treatment groups were not significantly different with regard to total blood loss and 1-year mortality rate. Patients who received aspirin and dipyridamole combined preoperatively had increased intraoperative blood loss compared with patients who did not receive antiplatelet medication (mean 309 mL vs. 214 mL). After age, sex, Charlson Comorbidity Index and duration of hospital stay were adjusted, no differences were seen in hazard ratios among the groups. – by Monica Jaramillo

 

Disclosures: The authors report no relevant financial disclosures.

 

Patients who received antiplatelet medication and underwent urgent surgery for hip fractures were not significantly different than patients who did not receive antiplatelet medication with regard to total blood loss, transfusion or 1-year mortality rates, according to recently published results. Researchers said the findings may indicate that patients can undergo urgent hip fracture surgery without drug cessation.

Researchers identified 176 patients who were 55 years of age or older with uncomplications hip fractures and underwent surgery within 48 hours after admission. Based on the preoperative medication regimen, 29 patients received aspirin and dipyridamole combined; 63 patients received aspirin alone; 29 patients received dipyridamole alone; and 56 patients did not receive antiplatelet medication. Investigators assessed total blood loss, transfusion rate and 1-year mortality rate.

Results showed the treatment groups were not significantly different with regard to total blood loss and 1-year mortality rate. Patients who received aspirin and dipyridamole combined preoperatively had increased intraoperative blood loss compared with patients who did not receive antiplatelet medication (mean 309 mL vs. 214 mL). After age, sex, Charlson Comorbidity Index and duration of hospital stay were adjusted, no differences were seen in hazard ratios among the groups. – by Monica Jaramillo

 

Disclosures: The authors report no relevant financial disclosures.

 

    Perspective
    Kenneth A. Egol

    Kenneth A. Egol

    With the aging population, an increasing number of elderly patients are being treated for hip fractures. Current estimates place this number above 300,000 hip fracture hospital admissions annually, which is expected to increase in the next decade. As this hip fracture population ages, an increasing number of patients have comorbidities requiring chronic anticoagulation medications. Treating physicians are often perplexed about how to manage the fracture in light of anticoagulation. The paper by Lin et al. adds to the already existing body of literature that demonstrates patients who present on antiplatelet medications can safely undergo hip fracture surgery within 48 hours with no increase in short term or long-term mortality. These authors focused on the use of Dipyridamole, whereas others have focus on other antiplatelet meds such as Clopidogrel. Our group has looked at these medications along with other anticoagulants and found that after controlling for age, co-morbidities, and anesthesia type, patients who presented on anticoagulation had similar lengths of stays, surgical outcomes, total complication rates, and admission costs to those patients not on anticoagulation.

     

    References:

     

    Doleman B, et al. Injury. 2015; doi: 10.1016/j.injury.2015.03.024.

    Gleason LJ, et al.. J Am Geriatr Soc. 2014; doi: doi: 10.1111/jgs.12591.

    Lott A, et al. Orthopedics. 2019 May doi: 10.3928/01477447-20190321-02.

    Tan T, et al. Thromb Res. 2015;doi: doi: 10.1016/j.thromres.2015.09.017.

    • Kenneth A. Egol, MD
    • Orthopedic surgeon
      NYU Langone Health
      New York

    Disclosures: Egol reports no relevant financial disclosures.