Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A systematic review and meta-analysis

Zhanyu Yang, Jiangdong Ni, Ze Long, Letian Kuang, Yongquan Gao, Shibin Tao, Zhanyu Yang, Jiangdong Ni, Ze Long, Letian Kuang, Yongquan Gao, Shibin Tao

Abstract

Background: Hip fractures are common and account for a large proportion of orthopedic surgical admissions in elderly patients. However, determining the timing for surgery has been controversial for patients who develop hip fractures while on antiplatelet treatment.

Methods: Computerized databases for studies published from the inception date to January 2020, including the Cochrane Library, PubMed (Medline), EMBASE, Web of ScienceTM, ClinicalTrials, ClinicalKey, and Google Scholar, were searched using the keywords "Hip AND Fracture", "Antiplatelet", "Antithrombocyte", "Platelet aggregation inhibitors", "Aspirin", "Plavix", and "Clopidogrel".

Results: In total, 2328 initial articles were identified. Twenty-four studies with 5423 participants were ultimately included in our analysis. Early surgery was associated with an increased transfusion rate in the antiplatelet group compared to the non-antiplatelet group (OR = 1.21; 95% CI, 1.01 to 1.44; p = 0.03). Early surgery for hip fracture patients on antiplatelet therapy was associated with a greater decrease in hemoglobin compared to delayed surgery (WMD = 0.75; 95% CI, 0.50 to 1.00; p < 0.001). However, early surgery appeared to decrease the length of hospitalization (WMD = - 6.05; 95% CI, - 7.06 to - 5.04; p < 0.001) and mortality (OR = 0.43; 95% CI, 0.23 to 0.79; p = 0.006).

Conclusion: It is unnecessary to delay surgery to restore platelet function when patients with hip fractures receive antiplatelet therapy. Furthermore, early surgery can significantly reduce mortality and hospital stay, which is conducive to patient recovery. Future randomized trials should determine whether the results are sustained over time.

Keywords: Aspirin; Hip fractures; Meta-analysis; Platelet aggregation inhibitors.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flowchart of the study selection procedure is presented
Fig. 2
Fig. 2
Meta-analysis of early surgery group and delayed surgery group: mortality
Fig. 3
Fig. 3
Meta-analysis of early surgery group and delayed surgery group: decrease in hemoglobin concentration
Fig. 4
Fig. 4
Meta-analysis of early surgery group and delayed surgery group: transfusion exposures
Fig. 5
Fig. 5
Meta-analysis of early surgery group and delayed surgery group: mean number of units of blood transfused
Fig. 6
Fig. 6
Meta-analysis of early surgery group and delayed surgery group: length of hospital stay
Fig. 7
Fig. 7
Meta-analysis of early surgery group and delayed surgery group: postoperative complications

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