title: Preoperative Use of Clopidogrel Does Not Affect Outcomes for Femoral Neck Fractures Treated With Hemiarthroplasty.
abstract: The antiplatelet effect of clopidogrel on blood loss and perioperative complications after surgical intervention remains ambiguous. The purpose of this study was to determine if patients on clopidogrel before hemiarthroplasty for femoral neck fracture are predisposed to greater surgical bleeding and perioperative complications compared with those not taking clopidogrel before surgery.
  
  
  
  We conducted a review of our electronic medical record from 2006-2013 and identified 602 patients who underwent 623 hemiarthroplasty procedures for displaced femoral neck fracture, of which 54 cases (9%) were taking clopidogrel before hospital admission. Patient demographics and comorbidities, operative and surgical variables, and perioperative complications at 90 days were compared between the clopidogrel and nonclopidogrel user groups.
  
  
  
  The 2 groups of patients had similar baseline characteristics, but patients taking clopidogrel preoperatively were sicker with higher American Society of Anesthesiologists scores (P = .049) and age-adjusted Charlson index (P = .001). They also had a greater incidence of cerebrovascular disease (P = .01), chronic obstructive pulmonary disease (P = .03), diabetes (0.03), and malignancy (P < .001). There was no significant difference between the 2 patient groups with respect to 90-day postoperative medical readmissions (P = .85), surgical readmissions (P = .26), infection (P = .99), and mortality (P = .89).
  
  
  
  Patients taking clopidogrel who present with a displaced femoral neck fracture can safely undergo a hemiarthroplasty while actively on clopidogrel without an increase in medical or surgical complications and mortality. We do not recommend delaying surgical intervention until the antiplatelet effects of clopidogrel subside.
authors.affiliation: Department of Orthopedics at Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Elie S
authors.initials: ES
authors.lastname: Ghanem
authors.affiliation: Department of Orthopedics at Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Raveesh D
authors.initials: RD
authors.lastname: Richard
authors.affiliation: Department of Orthopedics at Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Nathaniel C H
authors.initials: NCH
authors.lastname: Wingert
authors.affiliation: Department of Orthopedics at Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: James R
authors.initials: JR
authors.lastname: Gotoff
authors.affiliation: Center for Health Research, Henry Hood Research Center, Danville, Pennsylvania.
authors.forename: Jove H
authors.initials: JH
authors.lastname: Graham
authors.affiliation: Department of Orthopedics at Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Bowen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002561:Cerebrovascular Disorders; D000077144:Clopidogrel; D015897:Comorbidity; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011184:Postoperative Period; D012189:Retrospective Studies; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: antiplatelets; clopidogrel; fracture; hemiarthroplasty; outcomes