Platelet aggregometry for hip fracture surgery in patients treated with clopidogrel: a pilot study.

Autor: Tescione M; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. marcotescione.mt@gmail.com., Vadalà E; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Marano G; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Battaglia E; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Bruni A; Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy., Garofalo E; Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy., Longhini F; Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy., Rovida S; Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK., Polimeni N; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Squillaci R; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Lascala S; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Franco G; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Labate D; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Caracciolo M; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy., Macheda S; Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
Jazyk: angličtina
Zdroj: Journal of clinical monitoring and computing [J Clin Monit Comput] 2022 Jun; Vol. 36 (3), pp. 823-828. Date of Electronic Publication: 2021 May 06.
DOI: 10.1007/s10877-021-00714-z
Abstrakt: Surgery for hip fractures should be performed within 48 h from patient's admission. However, several factors including chronic antiplatelet therapy could delay operation. Among the totality of patients taking clopidogrel, up to 30% are resistant to the drug and have a normal platelets reactivity. We propose thromboelastography (TEG) with an ADP Platelet Mapping assay kit to assess platelet aggregation, a safe tool that could help to avoid surgery delay in those patients treated with antiplatelet therapy. A patient's blood sample was collected for aggregometry. If MA-ADP and platelets aggregation (%) were within normal values, the patient was fit for immediate surgery with neuraxial anesthesia and ultrasound-guided nerve block. If one of the two parameters or both were deranged, a mortality risk assessment was estimated. In the low risk category, the patients waited till normalization of the parameters, whereas in the high-risk group a general anesthesia and peripheral antalgic block was carried out. Nine patients were enrolled. Four of them showed normal aggregometry and surgery was performed within 24 h from admission. Two patients were classified as high mortality risk and surgery was carried out under general anesthesia. Three patients awaited operation till normalization of parameters. No peri or post-operative complications were reported. An aggregometry-guided protocol can safely expedite hip fracture surgery in patients taking clopidogrel. Nonetheless, in presence of a normal platelets function, clinician can opt for a neuraxial instead of general anesthesia reducing the incidence of postoperative delirium and cognitive dysfunction.Trial registration: prospectively registered at clinicaltrials.gov (NCT04642209; date of registration: 23rd November 2020).
(© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)
Databáze: MEDLINE
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