title: The effect of clopidogrel and aspirin on blood loss in hip fracture surgery.
abstract: BACKGROUND
  Anti-platelet drugs are commonly used for primary and secondary prevention of thrombo-embolic events and following invasive coronary interventions. Their effect on surgery-related blood loss and perioperative complications is unclear, and the management of trauma patients treated by anti-platelets is controversial. The anti-platelet effect is over in nearly 10 days. Notably, delay of surgical intervention for hip fracture repair for >48 h has been reported to increase perioperative complications and mortality.
  
  
  METHODS
  Intra-operative and perioperative blood loss, the amount of transfused blood and surgery-related complications of 44 patients on uninterrupted clopidogrel treatment were compared with 44 matched controls not on clopidogrel (either on aspirin alone or not on any anti-platelets).
  
  
  RESULTS
  The mean perioperative blood loss was 899±496 ml for patients not on clopidogrel, 1091±654 ml for patients on clopidogrel (p=0.005) and 1312±686 ml for those on combined clopidogrel and aspirin (p=0.0003 vs. all others). Increased blood loss was also associated with a shorter time to operation (p=0.0012) and prolonged surgical time (p=0.0002). There were no cases of mortality in the early postoperative period.
  
  
  CONCLUSIONS
  Patients receiving anti-platelet drugs can safely undergo hip fracture surgery without delay, regardless of greater perioperative blood loss and possible thrombo-embolic/postoperative bleeding events.
authors.affiliation: Department of Orthopedics B, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ofirchik@yahoo.com
authors.forename: Ofir
authors.initials: O
authors.lastname: Chechik
authors.forename: Ran
authors.initials: R
authors.lastname: Thein
authors.forename: Gil
authors.initials: G
authors.lastname: Fichman
authors.forename: Amir
authors.initials: A
authors.lastname: Haim
authors.forename: Tomer Ben
authors.initials: TB
authors.lastname: Tov
authors.forename: Ely L
authors.initials: EL
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin