Elsevier

Mayo Clinic Proceedings

Volume 88, Issue 2, February 2013, Pages 149-156
Mayo Clinic Proceedings

Original article
Safety of Clopidogrel in Hip Fracture Surgery

https://doi.org/10.1016/j.mayocp.2012.11.007Get rights and content

Abstract

Objective

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.

Results

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).

Conclusion

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.

Section snippets

Overview and Study Design

This study was a population-based, retrospective cohort study with a 2:1 matched comparison cohort using the database of the Rochester Epidemiology Project (REP). Epidemiological research in Olmsted County, Minnesota, is possible because the county is geographically isolated from other urban centers, and nearly all medical care is delivered to the population by a limited number of local health care providers. Providers of health care to the community have agreed to share their medical records

Results

Our search of the REP identified 2061 patients hospitalized for hip fracture during the study period, 40 (2%) of whom were identified as taking clopidogrel and made up the clopidogrel cohort. The control group comprised 80 patients matched 2:1 from among the remaining 2021 patients with hip fracture. Baseline characteristics are summarized in Table 1. Median age at hip fracture surgery was 83 years for the clopidogrel group and 84 years in the control group. The percentage of men was 45% in

Discussion

This observational study supports our hypothesis that there is no difference in perioperative bleeding complications or mortality in patients who undergo prompt operative treatment of hip fracture while taking clopidogrel compared with patients not taking clopidogrel.

Our clopidogrel cohort and control cohort were similar. There was no significant operative delay in either cohort: on average, both groups had surgical intervention within 36 hours of admission. This is important because most prior

Conclusion

We conducted an observational, population-based, retrospective cohort study to test the hypothesis that there is no increase in postoperative bleeding complications or mortality in patients who undergo prompt operative treatment of hip fracture while taking clopidogrel. Although the small sample size in our study precludes making a definitive conclusion, we found no evidence that prompt surgical treatment of hip fracture in patients taking clopidogrel compromises perioperative outcomes.

Acknowledgments

We thank Donna K. Lawson, LPN, and Kathleen E. Wolfert, RN, BSN, for their help in data collection and management. Data were analyzed by Christine M. Lohse, MS.

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the study sponsors.

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    Citation Excerpt :

    Some examples can be seen in other realms of surgery, including orthopedic hip surgery. A retrospective cohort study found no difference in perioperative bleeding complications or mortality in patients undergoing hip fracture surgery between patients with perioperative clopidogrel therapy and those without (18). An analysis of 102 patients undergoing hemiarthoplasty showed no statistically significant difference in multiple bleeding outcomes, including pre- and postoperative hemoglobin levels and transfusion rates between groups receiving clopidogrel preoperatively and those not receiving clopidogrel (26).

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Grant Support: This study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc, and grant number R01-AR30582 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases). The study was funded by an internal grant from the Mayo Clinic Division of General Internal Medicine and a Write-up and Publish (WRAP) grant from the Mayo Clinic Department of Medicine.

Potential Competing Interests: Dr Mabry has a pending contract with Zimmer to provide consultation regarding a new total knee prosthesis. Dr Sems receives royalties from DePuy Orthopaedics, Inc, for a hip implant he designed.

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