Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality

Abstract

ObjectiveA review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48h) versus delayed surgery (>5 days).Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study Patients and methodsA total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients.The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. ResultsBleeding, transfusion requirements and analytical results showed no significant differences between groups.More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not have that.Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9–0.9) and number of transfusions (OR: 1.1–1.5).The average length of stay was 4.1 days greater in the delayed surgery group. ConclusionEarly surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay.The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.