title: Discontinuation of Plavix®(clopidogrel) for hip fracture surgery. A systematic review of the literature.
abstract: The elderly population is increasing worldwide, associated with an increase in diseases related to aging, such as hip fractures. These patients are sometimes treated with clopidogrel. There are no arguments at present to clearly determine the risk/benefit ratio of early surgical management of traumatic hip fractures in patients treated with clopidogrel (perioperative blood loss, postoperative complications). The goal of this systematic review of the literature was to show that early surgical management (<48h) of patients treated with clopidogrel does not increase postoperative morbidity or mortality. Systematic review of the literature: level of evidence IV. A bibliographic search was performed in July 2015 in PubMed, Embase and Cochrane databases using the MeSh keywords "Clopidogrel or Plavix®" AND "hip fracture". Two of the authors analyzed 48 articles based on the title and abstract. Twenty-one articles were selected and read completely with an analysis of the references. Nine articles were chosen. Early surgical management (<48h) of patients receiving clopidogrel did not increase mortality at 30days, 3months or 1 year (between 25 and 30% mortality at 1 year) and did not result in an increase in perioperative bleeding. The risk/benefit ratio of early surgical management of patients with hip fractures receiving clopidogrel is good; morbidity and mortality are not increased in these patients if surgery is performed immediately or less than 48h after admission.
  
  
  
  IV.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, Martinique; Service d'anesthésie, hôpital Cochin, Paris 5 université, 75014 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Mattesi
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, Martinique; Service d'anesthésie, hôpital Cochin, Paris 5 université, 75014 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Noailles
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, Martinique; Service d'anesthésie, hôpital Cochin, Paris 5 université, 75014 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Rosencher
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS 90632, 97261 Fort-de-France cedex, Martinique; Service d'anesthésie, hôpital Cochin, Paris 5 université, 75014 Paris, France. Electronic address: Jean-Louis.Rouvillain@chu-fortdefrance.fr.
authors.forename: J-L
authors.initials: JL
authors.lastname: Rouvillain
mesh_terms: D016063:Blood Loss, Surgical; D000077144:Clopidogrel; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D018570:Risk Assessment; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Clopidogrel; Delay to surgery; Hip fracture; Plavix(®); Postoperative morbidity and mortality