The effect of clopidogrel and aspirin on blood loss in hip fracture surgery

Introduction: Anti-platelet drugs are commonly used for primary and secondary prevention of thrombo-embolic events and following invasive coronary interventions. Their effect on surgery-related blood loss and perioperative complications is unclear, and the management of trauma patients treated by anti-platelets is controversial. The anti-platelet effect is over in nearly 10 days. Notably, delay of surgical intervention for hip fracture repair for >48 h has been reported to increase perioperative complications and mortality. Patients and methods: Intra-operative and perioperative blood loss, the amount of transfused blood and surgery-related complications of 44 patients on uninterrupted clopidogrel treatment were compared with 44 matched controls not on clopidogrel (either on aspirin alone or not on any anti-platelets). Results: The mean perioperative blood loss was 899 ± 496 ml for patients not on clopidogrel, 1091 ± 654 ml for patients on clopidogrel (p = 0.005) and 1312 ± 686 ml for those on combined clopidogrel and aspirin (p = 0.0003 vs. all others). Increased blood loss was also associated with a shorter time to operation (p = 0.0012) and prolonged surgical time (p = 0.0002). There were no cases of mortality in the early postoperative period. Conclusions: Patients receiving anti-platelet drugs can safely undergo hip fracture surgery without delay, regardless of greater perioperative blood loss and possible thrombo-embolic/postoperative bleeding events.