title: Clopidogrel: is a surgical delay necessary in fractured neck of femur?
abstract: BACKGROUND
  This paper assesses the outcomes of patients after surgery for a proximal femur fracture while on clopidogrel. It describes a single-centre retrospective observational study over a two-year period.
  
  
  METHODS
  A total of 31 surgical patients were included in this study. Of these, 28 were on clopidogrel and 3 on dipyridamole. Patients were split into subgroups based on when surgery took place and the type of hip fracture. The 'early surgery' (<48 hours from admission to theatre) group contained 16 patients (51.6%) and the 'late surgery' (>48 hours) group composed 15 patients (48.4%). Type of surgery performed and pre-and postoperative haemoglobin (Hb) levels were recorded. Furthermore, the number of units of blood transfused per patient as well as complications before and after surgery were noted.
  
  
  RESULTS
  A significantly larger mean hb drop occurred in the early surgery group (3.2g/dl) compared with the late surgery group (2.3g/dl) (p=0.027). The mean length of inpatient stay was 21 days in the early and 23 days in the late group (p=0.456). A significantly larger hb mean drop occurred in patients with extracapsular hip fractures (3.4g/dl; n=16) compared with patients with intracapsular fractures (2.3g/dl; n=15) (p=0.020). The extracapsular patients had longer stays in hospital: 24.5 days versus 19.8 days in the intracapsular group (p=0.521). There was no statistical difference in the 30-day mortality between the early surgery (3/16 deaths) and late surgery (2/15 deaths) groups (p=0.481).
  
  
  CONCLUSIONS
  Patients with extracapsular fractures, treated with early surgery, appear to be most at risk of complications after surgery.
authors.affiliation: Wrightington, Wigan and Leigh Foundation NHS Trust, UK. iheanyi@doctors.net.uk
authors.forename: Iheanyi C
authors.initials: IC
authors.lastname: Nwachuku
authors.forename: Morgan
authors.initials: M
authors.lastname: Jones
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Clough
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D000077144:Clopidogrel; D004176:Dipyridamole / Q000627:therapeutic use; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine