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

Autor:	Yongquan Gao, Shi-Bin Tao, Zhan-Yu Yang, Jiangdong Ni, Letian Kuang, Ze Long
Rok vydání:	2020
Předmět:	medicine.medical_specialty lcsh:Diseases of the musculoskeletal system Cochrane Library law.invention Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Randomized controlled trial lcsh:Orthopedic surgery law Platelet aggregation inhibitors medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Randomized Controlled Trials as Topic 030222 orthopedics Aspirin Hip fracture business.industry Hip Fractures Length of Stay Clopidogrel medicine.disease Surgery lcsh:RD701-811 Observational Studies as Topic Meta-analysis Orthopedic surgery Platelet aggregation inhibitor Patient Safety lcsh:RC925-935 business medicine.drug Research Article
Zdroj:	Journal of Orthopaedic Surgery and Research Journal of Orthopaedic Surgery and Research, Vol 15, Iss 1, Pp 1-14 (2020)
ISSN:	1749-799X
Popis:	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.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::775fb7aa1dbd2de29e5b15e5b97af3b7 https://pubmed.ncbi.nlm.nih.gov/32164755 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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