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Safety of Clopidogrel in Hip Fracture Surgery



      To compare postoperative outcomes of hip fracture surgery in patients who were and were not taking clopidogrel at the time of surgery.

      Patients and Methods

      Using the Rochester Epidemiology Project database, we performed a population-based, retrospective cohort study comparing patients who were and were not taking clopidogrel at the time of hip fracture surgery between January 1, 1996, and June 30, 2010. Primary outcomes were perioperative bleeding and mortality. Secondary outcomes were perioperative thrombotic events.


      During the study period, 40 residents of Olmsted County, Minnesota (median age, 83 years), who were taking clopidogrel underwent hip fracture repair. These 40 patients were matched 2:1 with 80 control patients (median age, 84 years). The groups were similar in age, sex, American Society of Anesthesiologists score, type of surgical procedure, and use of deep venous thrombosis prophylaxis. The mean time from admission to surgery was less than 36 hours for each cohort. Perioperative bleeding complications and mortality were not significantly different between patients who were and were not taking clopidogrel at the time of hip fracture surgery. Combined bleeding outcome criteria was met in 48% of the clopidogrel cohort and 45% of the control cohort (relative risk, 1.06; 95% CI, 0.70-1.58; P=.80). One-year mortality was 28% in the clopidogrel cohort and 29% in the control cohort (hazard ratio, 1.33; 95% CI, 0.84-2.12; P=.23).


      Although the small sample size precludes making a definitive conclusion, we found no evidence that prompt surgical treatment of hip fracture in patients taking clopidogrel compromises perioperative outcomes.

      Abbreviations and Acronyms:

      DVT (deep venous thrombosis), REP (Rochester Epidemiology Project)
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        • Plavix
        ([package insert]) Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, Bridgewater, NJ2011
        • Collyer T.C.
        • Reynolds H.C.
        • Truyens E.
        • Kilshaw L.
        • Corcoran T.
        Perioperative management of clopidogrel therapy: the effects on in-hospital cardiac morbidity in older patients with hip fractures.
        Br J Anaesth. 2011; 107: 911-915
        • Chassot P.G.
        • Delabays A.
        • Spahn D.R.
        Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction.
        Br J Anaesth. 2007; 99: 316-328
        • Iakovou I.
        • Schmidt T.
        • Bonizzoni E.
        • et al.
        Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.
        JAMA. 2005; 293: 2126-2130
        • Inman D.S.
        • Michla Y.
        • Partington P.F.
        Perioperative management of trauma patients admitted on clopidogrel (Plavix): a survey of orthopaedic departments across the United Kingdom.
        Injury. 2007; 38: 625-630
        • Lavelle W.F.
        • Demers Lavelle E.A.
        • Uhl R.
        Operative delay for orthopedic patients on clopidogrel (Plavix): a complete lack of consensus.
        J Trauma. 2008; 64: 996-1000
        • Palan J.
        • Odutola A.
        • White S.P.
        Is clopidogrel stopped prior to hip fracture surgery—a survey of current practice in the United Kingdom.
        Injury. 2007; 38: 1279-1285
        • Harty J.A.
        • McKenna P.
        • Moloney D.
        • D'Souza L.
        • Masterson E.
        Anti-platelet agents and surgical delay in elderly patients with hip fractures.
        J Orthop Surg (Hong Kong). 2007; 15: 270-272
        • Johansen A.
        • White J.
        • Turk A.
        Clopidogrel therapy—implications for hip fracture surgery.
        Injury. 2008; 39: 1188-1190
        • Leonidou A.
        • Cam N.B.
        • Chambers I.R.
        Femoral neck fractures in patients on Clopidogrel: the effect of delaying surgery and the introduction of the new SIGN guidelines.
        Surgeon. 2011; 9: 318-321
        • Sim W.
        • Gonski P.N.
        The management of patients with hip fractures who are taking Clopidogrel.
        Australas J Ageing. 2009; 28: 194-197
        • Nydick J.A.
        • Farrell E.D.
        • Marcantonio A.J.
        • Hume E.L.
        • Marburger R.
        • Ostrum R.F.
        The use of clopidogrel (Plavix) in patients undergoing nonelective orthopaedic surgery.
        J Orthop Trauma. 2010; 24: 383-386
        • Melton III, L.J.
        History of the Rochester Epidemiology Project.
        Mayo Clin Proc. 1996; 71: 266-274
        • Stone D.H.
        • Goodney P.P.
        • Schanzer A.
        • et al.
        • Vascular Study Group of New England
        Clopidogrel is not associated with major bleeding complications during peripheral arterial surgery.
        J Vasc Surg. 2011; 54: 779-784
        • Au A.G.
        • Majumdar S.R.
        • McAlister F.A.
        Preoperative thienopyridine use and outcomes after surgery: a systematic review.
        Am J Med. 2012; 125: 87-99.e1
        • Chechik O.
        • Thein R.
        • Fichman G.
        • Haim A.
        • Tov T.B.
        • Steinberg E.L.
        The effect of clopidogrel and aspirin on blood loss in hip fracture surgery.
        Injury. 2011; 42: 1277-1282
        • Chechik O.
        • Amar E.
        • Khashan M.
        • Kadar A.
        • Rosenblatt Y.
        • Maman E.
        In support of early surgery for hip fractures sustained by elderly patients taking clopidogrel: a retrospective study.
        Drugs Aging. 2012; 29: 63-68
        • Bentler S.E.
        • Liu L.
        • Obrizan M.
        • et al.
        The aftermath of hip fracture: discharge placement, functional status change, and mortality.
        Am J Epidemiol. 2009; 170: 1290-1299