Dr. Molly Feely, a consultant in the Division of General Internal Medicine at Mayo Clinic in Rochester, MN, discusses her article appearing in the February 2013 issue of Mayo Clinic Proceedings, where no perioperative complications were found when comparing outcomes between patients with hip fractures using and not using clopidogrel. The Rochester Epidemiology Project provided the patient data. Available at:
My name is molly feely and i am a consultant physician in the division of general internal medicine here at the mayo clinic in rochester the title of my article is the safety of clopidogrel in hip fracture surgery it’s appearing in an upcoming edition of mayo clinic proceedings plavix or clopidogrel was introduced in the late 1990s as a platelet inhibitor it’s
Widely used now and in has a number of indications it irreversibly inhibits the platelet for the life of the platelet and so it takes a long time for plavix to wear off once it started this creates a conundrum in hip fracture surgery because what do you do when you have a patient who’s on plavix who comes in with a hip fracture the surgeon is always trying to
Balance the risk of taking them to surgery and having increased bleeding versus delaying surgery and having a risk of increased thrombosis with the patient off of plavix therefore we did a retrospective observational cohort study looking at patients who came into the hospital who are with a hip fracture who were on plavix versus and compared them to a cohort of
Patients who with hip fracture who were not on clavicus our study was unique in that our patient population was a population-based study and we also used the rochester epidemiology project so that we had complete follow-up of all of our patients that we that were and entered into the study we also were fortunate in that many of the other studies out there that
Look at clopidogrel and hip fracture are complicated by surgical delay in the patients who are on plavix at the time of their hip fracture that’s difficult because one doesn’t know if the complications that patients have after surgery are due to the protocol or are they due to the surgical delay our study was also pertinent that our patients had no no demonstrable
Surgical delay whether they were on plavix or not on plavix at the time of their surgery we looked at several outcomes in these patients we looked at bleeding outcomes in several different ways we also looked at thrombotic complications such as heart attack stroke or limb ischemia after surgery and we also looked at overall mortality between the clopidogrel group and
The non-critical group our study showed no difference in any of the bleeding outcomes between the critical group and the non-political group and our study showed no difference in thrombotic complications between the two groups and there was no difference in mortality between the two groups we concluded that our study showed no increase in perioperative complications
In patients on clopidogrel at the time of their hip fracture who were taken to surgery promptly so this adds considerably to a growing body body of literature that suggests that it’s safe to operate on patients on clopidogrel promptly however our study size was too small to make definitive conclusions that would change practice today it would be very nice to have
A much larger study to look at outcomes it would be great to have a double-blind placebo-controlled prospective randomized controlled trial however i think we’re close to having enough studies and out there to potentially do a meta-analysis incan in conclusion our study showed that there was no increase in perioperative complications in patients who were taking
Patients on clopidogrel who were taken for their hip fracture surgery promptly versus those who were not annika pretty girl we hope you’ve benefitted from this presentation based on the content of mayo clinic proceedings our journal’s mission is to promote the best interests of patients by advancing the knowledge and professionalism of the in community if you’re
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Transcribed from video
Safety of Clopidogrel in Hip Fracture Surgery By Mayo Proceedings
