Is clopidogrel stopped prior to hip fracture surgery--A survey of current practice in the United Kingdom.
BACKGROUND
Clopidogrel is an anti-platelet agent which causes an increase in bleeding time. An increasing number of patients presenting with an acute femoral neck fracture take clopidogrel in combination with other anti-platelet agents as regular prescription medication. Such patients may be at higher risk of increased peri-operative bleeding. No guidelines or recommendations currently exist regarding the routine discontinuation of clopidogrel in patients with fracture of the femoral neck awaiting surgery.


METHODS
A telephone questionnaire was undertaken to examine the current practice amongst 110 orthopaedic departments in the UK regarding the discontinuation of clopidogrel prior to trauma surgery for femoral neck fractures. This was compared to the practice of discontinuing aspirin and warfarin in the same patient groups in these departments.


RESULTS
There appears to be significant variation in practice amongst orthopaedic departments with 43.6% having a policy of discontinuing clopidogrel. This compares to 37.3% of trusts having a policy of stopping aspirin and 97.3% stopping warfarin.


CONCLUSIONS
There is wide variation in practice regarding the discontinuation of clopidogrel preoperatively in patients due to undergo surgery for femoral neck fractures. These findings highlight the need to develop guidelines for the preoperative management of these patients.
Palan
Jeya
J
Nuffield Department of Orthopaedic Surgery, Botnar Research Centre, Nuffield Orthopaedic Centre, University of Oxford, Oxford, Oxfordshire OX3 7DR, United Kingdom. Jeya_Palan@hotmail.com
Odutola
Adekoyejo
A
White
Simon P
SP
D000925:Anticoagulants; D001241:Aspirin; D002985:Clinical Protocols; D000077144:Clopidogrel; D000075202:Contraindications; D005265:Femoral Neck Fractures / Q000601:surgery*; D019538:Health Care Surveys; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D011300:Preoperative Care; D011364:Professional Practice; D013503:Surgery Department, Hospital; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006113:United Kingdom; D014859:Warfarin
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin