title: [Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality].
abstract: OBJECTIVE
  A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study
  
  
  METHODS
  A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood.
  
  
  RESULTS
  Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group.
  
  
  CONCLUSIONS
  Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, España. jmas@comll.cat
authors.forename: J
authors.initials: J
authors.lastname: Mas-Atance
authors.forename: C
authors.initials: C
authors.lastname: Marzo-Alonso
authors.forename: M
authors.initials: M
authors.lastname: Matute-Crespo
authors.forename: J J
authors.initials: JJ
authors.lastname: Trujillano-Cabello
authors.forename: N
authors.initials: N
authors.lastname: Català-Tello
authors.forename: M
authors.initials: M
authors.lastname: de Miguel-Artal
authors.forename: P
authors.initials: P
authors.lastname: Forcada-Calvet
authors.forename: J J
authors.initials: JJ
authors.lastname: Fernández-Martínez
mesh_terms: D000369:Aged, 80 and over; D061345:Early Medical Intervention; D005260:Female; D006620:Hip Fractures / Q000097:blood / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Agregometría por impedancia; Antiagregantes plaquetarios; Antiplatelet agents; Demora quirúrgica; Fractura de cadera; Hip fracture; Impedance aggregometry; Mortalidad; Mortality; Surgical delay