title: Is early hip fracture surgery safe for patients on clopidogrel? Systematic review, meta-analysis and meta-regression.
abstract: BACKGROUND
  Hip fracture is a common presentation in the elderly population, many of whom will be taking the antiplatelet clopidogrel, which has the potential to increase perioperative bleeding. The aim of this systematic review and meta-analysis was to answer the questions: (1) is early hip fracture surgery for patients on clopidogrel associated with worse postoperative outcomes compared to patients not on clopidogrel? (2) is early versus delayed surgery for these patients associated with worse postoperative outcomes?
  
  
  METHODS
  A systematic search was conducted of MEDLINE, EMBASE, Cinahl and AMED databases. Results from patients undergoing early surgery on clopidogrel were compared to a control group not taking clopidogrel. In addition, patients taking clopidogrel undergoing early and delayed surgery were compared.
  
  
  RESULTS
  For patients taking clopidogrel undergoing early surgery, there was no associated increase in overall mortality (OR 0.89; 95% CI: 0.58-1.38) or 30-day mortality (OR 1.10 95% CI: 0.48-2.54). However, there was an associated increase in blood transfusion (OR 1.41 95% CI: 1.00-1.99). There was an associated decreased length of stay in the early surgery versus delayed surgery group (weighted mean difference -7.09 days (95% CI: -10.14 to -4.04).
  
  
  CONCLUSIONS
  Early surgery appears safe for patients with hip fracture though there may be a small increase in the rate of blood transfusion. However, larger prospective trials are required to confirm these findings.
authors.affiliation: Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Doleman
authors.affiliation: Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom. Electronic address: iain.moppett@nottingham.ac.uk.
authors.forename: I K
authors.initials: IK
authors.lastname: Moppett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D000077144:Clopidogrel; D000075202:Contraindications; D003430:Cross-Sectional Studies; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D011184:Postoperative Period; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Antiplatelets; Blood transfusion; Clopidogrel; Hip fracture; Mortality