Effects of anticoagulants on outcome of femoral neck fracture surgery.
OBJECTIVE
To review records of 330 patients who underwent surgery for femoral neck fractures with or without preoperative anticoagulation therapy.


METHODS
Medical records of 235 women and 95 men aged 48 to 103 years (mean, 81.6; standard deviation [SD], 13.1) who underwent surgery for femoral neck fractures with or without preoperative anticoagulation therapy were reviewed. 30 patients were on warfarin, 105 on aspirin, 28 on clopidogrel, and 167 were controls. The latter 3 groups were combined as the non-warfarin group and compared with the warfarin group. Hospital mortality, time from admission to surgery, length of hospital stay, return to theatre, and postoperative complications (wound infection, deep vein thrombosis, and pulmonary embolism) were assessed.


RESULTS
The warfarin and control groups were significantly younger than the clopidogrel and aspirin groups (80.8 vs. 80.0 vs. 84.2 vs. 83.7 years, respectively, p<0.05). 81% of the patients underwent surgery within 48 hours of admission. The overall mean time from admission to surgery was 1.8 days; it was longer in the warfarin than the aspirin, clopidogrel, and control groups (3.3 vs. 1.8 vs. 1.6 vs. 1.6 days, respectively, p<0.001). The mean length of hospital stay was 17.5 (SD, 9.6; range, 3-54) days. The overall hospital mortality was 3.9%; it was 6.7% in the warfarin group, 3.8% in the aspirin group, 3.6% in the clopidogrel group, and 3.6% in the control group (p=0.80). Four patients returned to theatre for surgery: one in the warfarin group for washout of a haematoma, 2 in the aspirin group for repositioning of a mal-fixation and for debridement of wound infection, and one in the control group for debridement of wound infection. The warfarin group did not differ significantly from non-warfarin group in terms of postoperative complication rate (6.7% vs. 2.7%, p=0.228) and the rate of return to theatre (3.3% vs. 1%, p=0.318).


CONCLUSIONS
It is safe to continue aspirin and clopidogrel prior to surgical treatment for femoral neck fracture. The risk of delaying surgery outweighs the peri-operative bleeding risk.
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia & Orthopaedic Research Unit, The Prince Charles Hospital, Queensland, Australia.
Bastiaan L
BL
Ginsel
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
Ahmad
A
Taher
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
Sarah L
SL
Whitehouse
Department of Nutrition and Dietetics, The Prince Charles Hospital, Queensland, Australia.
Jack J
JJ
Bell
Department of Geriatrics, The Prince Charles Hospital, Queensland. Australia.
Chrys R
CR
Pulle
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia & Orthopaedic Research Unit, The Prince Charles Hospital, Queensland, Australia.
Ross W
RW
Crawford
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D000077144:Clopidogrel; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
clopidogrel; femoral neck fractures; hospital mortality; warfarin