Anticoagulants on Outcome of
Femoral Neck Fracture Surgery
Pembimbing: Letkol CKM dr. Basuki
Widodo, Sp.OT
Aini Fuada Sardjono (1420221176)
Abstract
Purpose. To review records of 330
patients who underwent surgery for
femoral neck fractures with or
without preoperative anticoagulation
therapy.
Abstract (contd)
Methods
Abstract (contd)
Results
Category
Warfarin
Aspirin
Clopidogr
el
Control
Age
80.8
83.7
84.2
80.0
The patients
underwent surgery
The overall mean time
from admission to
surgery (1.8 days)
1.8
1.6
1.6
354 days
6.7%
3.8%
3.6%
3.6%
Postoperative
complication rate
1 haematoma
2 repositioning of
a malfixation and
for debridement
of wound
infection
1
debridemen
t of wound
infection
Abstract (contd)
Conclusion. 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
INTRODUCTION
INTRODUCTION(Contd)
RESULTS
Group
No. of M e a n
male:
age
female ( y e a r s )
Warfarin (n=30)
8 :2 2
Non-warfarin (n=300) 8 7 : 2 1 3
Aspirin (n=105)
35:70
Clopidogrel (n=28)
9 :1 9
Control (n=167)
4 3 :1 2 4
80.8
81.7
83.7
84.2
80.0
M ean
le n g th o f
h o s p ita l
s ta y (d a y s )
M ean
tim e fr o m
a d m is s io n
to s u rg e ry
(d a y s )
N o . ( % ) o f p a t ie n t s
W ound
in fe c tio n
19.3
17.7
19.4
17.3
16.7
3.3
1.7
1.8
1.6
1.6
2 (6.7)
8 (2.7)
2 (1.9)
0 (0)
6 (3.6)
D eep
P u lm o n a r y R e t u r n t o
venous
e m b o lis m
th e a tre
th ro m b o s is
0 (0)
3 (1.0)
2 (1.9)
0 (0)
1 (0.6)
1
5
2
1
2
(3 .3 )
(1 .7 )
(1 .9 )
(3 .6 )
(1 .2 )
1 (3.3)
3 (1.0)
2 (1.9)
0 (0)
1 (0.6)
Hospital
mortality
2
11
4
1
6
(6 .7 )
(3 .7 )
(3 .8 )
(3 .6 )
(3 .6 )
DISCUSSION
This study suggested that aspirin or
clopidogrel had minimal impact on hospital
mortality and postoperative complication rate,
whereas the time from admission to surgery
was longer in patients on warfarin.
The use of clopidogrel is reported to increase
bleeding and complication rates. Compared
with those not on clopidogrel, patients on
clopidogrel had approximately 200 ml higher
blood loss and had an increased complication
rate.
DISCUSSION
Patients on clopidogrel had increased risks of
bleeding and postoperative complications when
undergoing surgery within 48 hours of admission,
compared with those undergoing surgery after 48
hours of admission.
Nonetheless, confounders such as surgical
approach, surgical technique, and operating time
were not adjusted for. The increased blood loss was
not only due to the use of clopidogrel.
When clopidrogel was stopped preoperatively, 20%
of high-risk patients experienced an acute coronary
syndrome between postoperative days 4 and 8.
Discussion
Delayed surgery is associated with one-year
mortality in patients on clopidogrel with femoral
neck fracture.
Early operative treatment according to the Scottish
Intercollegiate Guidance Network guidelines is
suggested.
The British Orthopaedic Association stresses the
importance of early surgery for patients with hip
fracture, and sets a maximum delay of 48 hours.
Compared with those not on warfarin, patients on
warfarin have higher risks of postoperative wound
infection after total hip/knee replacement
Discussion
In our study, the lack of significant
differences between the 4 groups in
terms of hospital mortality and
complications may have been due to
a type-II error; the number of
patients was relatively small in the
clopidogrel and warfarin groups. The
mean patient age also differed
significantly between groups,
although it is unlikely to have been a
CONCLUSION
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
Critical Appraisal
Kriteria
Deskripsi Judul
Menggambarkan isi
utama penelitian,
menarik dan tanpa
singkatan
Korespondensi penulis
Abstrak
No.
Kriteria
- (339)
Pendahuluan
No.
Kriteria
Kriteria
Waktu +, tempat -
Populasi Sumber
Teknik sampling
Kriteria inklusi
Kriteria eksklusi
Blind
10
Uji statistik
11
Program komputer
12
Penentuan Subjek
Hasil
No.
Kriteria
Jumlah subjek
Tabel Karakteristik
Pembahasan, Kesimpulan,
Daftar Pustaka
No.
Kriteria
Keterbatasan penelitian
+ (jumlah sampel
yang sedikit, range
usia)
Saran Penelitian
Aplikasi
Pertanyaan
Jawaban
Tidak
Tidak
Ya
Study Validity
Research Question
Study Validity
Follow-up
Results
Selection of outcomes
Thank You