title: Factors influencing mortality in patients on antiplatelet agents presenting with proximal femoral fractures.
abstract: OBJECTIVE
  To identify factors predicting one-year mortality in patients on clopidogrel presenting with proximal femoral fractures.
  
  
  METHODS
  9 men and 22 women aged 64 to 97 (mean, 81; standard deviation, 8) years who had been taking clopidogrel for ischaemic heart disease (n=15), cerebrovascular disease (n=6), or both (n=10) presented with proximal femoral fractures. The time from injury to operation, type of anaesthesia, treatment method, and postoperative complications were reviewed. One-year mortality was analysed using the Kaplan-Meier curve. Factors predicting one-year mortality were identified.
  
  
  RESULTS
  The fracture configurations of the 31 patients included intracapsular femoral neck fracture (n=17), intertrochanteric fracture (n=13), and subtrochanteric fracture (n=1). 30 of the patients underwent hemiarthroplasty (n=16), dynamic hip screw fixation (n=9) or intramedullary hip screw fixation (n=5). The remaining patient underwent conservative treatment owing to metastatic prostate cancer. Of the 30 patients who underwent surgery, clopidogrel was discontinued at least 7 days prior to surgery, with the mean delay to surgery being 8.4 (range, 2-16) days. No patient had excessive blood loss at operation, although 7 patients received a blood transfusion postoperatively. 13 (43%) patients developed postoperative complications. The one-year mortality was 26% (8/31). Univariate analysis showed that factors predicting one-year mortality were spinal anaesthesia (p=0.04), postoperative blood transfusion (p=0.03), postoperative complications (p=0.03), and delay to surgery (p=0.03). Multiple regression analysis showed that delay to surgery (p=0.03) was the only independent predictor of one-year mortality, with a hazard ratio of 1.357 (95% confidence interval, 1.03-1.79).
  
  
  CONCLUSIONS
  Surgery should be performed as soon as possible in medically fit patients having proximal femoral fractures who are taking clopidogrel, as delay to surgery is associated with increased one-year mortality.
authors.affiliation: Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, United Kingdom. rohitmh@yahoo.com
authors.forename: Rohit
authors.initials: R
authors.lastname: Maheshwari
authors.forename: Mehool
authors.initials: M
authors.lastname: Acharya
authors.forename: Maureen
authors.initials: M
authors.lastname: Monda
authors.forename: Radhakant
authors.initials: R
authors.lastname: Pandey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000517:prevention & control; D000077144:Clopidogrel; D015897:Comorbidity; D005265:Femoral Neck Fractures / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D005593:Fracture Fixation, Internal; D006620:Hip Fractures / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine