OTA 2012 Posters

Scientific Poster #11 Hip/Femur OTA-2012

Is Operative Delay in Hip Fracture Patients on Clopidogrel (Plavix) Warranted? A Comorbidity Matched Analysis

Chris Casstevens, MD; J. Patrick Martens; Michael T. Archdeacon, MD;
B. J. Johnson; Theodore Toan Le, MD; John D. Wyrick;
Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA

Purpose: There is a paucity of literature that addresses potential delays in operative treatment for hip fracture patients who present with inhibited platelet function secondary to antiplatelet medications. The purpose of this study was to compare the occurrence and magnitude of operative delay, surgical blood loss, and 1-year mortality for hip fracture patients on clopidogrel to a comorbidity-matched cohort not on clopidogrel.

Methods: We queried our billing database for hip fracture patients treated operatively over a 9-year period. We identified patients who presented on clopidogrel (Group P) and calculated the Charlson Comorbidity Index for this group. A matched control group of patients not on clopidogrel preoperatively was selected with matching age-adjusted Charlson scores (Group N). The groups were compared using standard t tests, Wilcoxon rank-sum tests, χ2 tests, or a two-tailed Fisher exact test. For mortality, a McNemar test for discordant pairs was used to analyze the data in a matched fashion.

Results: We identified 27 (4.8%) of 557 patients with a mean age of 79.1 ± 10.1 years who were taking clopidogrel at presentation with a hip fracture (Group P). The control group used for comparison consisted of 27 patients drawn from the same search matched with the same age-adjusted Charlson score (Group N). Median operative delay was 4 days in Group P and 1 day in Group N (P <0.01). Median estimated operative blood loss was 200 mL in both groups (P = 0.99). One-year mortality was 30% (8 of 27) in both groups (P = 1.0) with no significant difference noted using the McNemar test (P = 1.0).

Conclusions: Our data demonstrated an increase in operative delay among patients on clopidogrel; however, the effects of clopidogrel on platelet function did not appear to have an adverse effect on hemostasis in these hip fracture patients. The morbidity and mortality in hip fracture patients on clopidogrel at admission were nearly identical to those seen in patients with comparable levels of medical comorbidities not taking clopidogrel.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.