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Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?

BACKGROUND: Antiplatelet medication has been frequently performed in elderly patients with hip fracture, because of comorbidities. This observational cohort study was to evaluate the effect of continuous perioperative antiplatelet medication on the outcomes after cephalomedullary nailing (CMN) in el...

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Autores principales: Jang, Chul-Young, Kwak, Dae-Kyung, Kim, Dae-Hwan, Lee, Hyung-Min, Hwang, Ji-Hyo, Yoo, Je-Hyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434804/
https://www.ncbi.nlm.nih.gov/pubmed/30909898
http://dx.doi.org/10.1186/s12891-019-2504-5
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author Jang, Chul-Young
Kwak, Dae-Kyung
Kim, Dae-Hwan
Lee, Hyung-Min
Hwang, Ji-Hyo
Yoo, Je-Hyun
author_facet Jang, Chul-Young
Kwak, Dae-Kyung
Kim, Dae-Hwan
Lee, Hyung-Min
Hwang, Ji-Hyo
Yoo, Je-Hyun
author_sort Jang, Chul-Young
collection PubMed
description BACKGROUND: Antiplatelet medication has been frequently performed in elderly patients with hip fracture, because of comorbidities. This observational cohort study was to evaluate the effect of continuous perioperative antiplatelet medication on the outcomes after cephalomedullary nailing (CMN) in elderly patients with a proximal femur fracture. METHODS: One hundred and sixty-two consecutive patients aged ≥70 years undergoing CMN for proximal femur fracture between January 2015 and January 2017 were recruited. Of the 162 patients, 47 (study group) taking antiplatelets preoperatively due to comorbidities were compared with 107 (control group) who were not on antiplatelets. 8 patients taking anticoagulant medication were excluded. Postoperative hemoglobin (Hb) and hematocrit (Hct) levels, transfusion amount and estimated blood loss (EBL), occurrence of venous thromboembolism (VTE) and delirium, intensive care unit (ICU) admission, complications, length of hospital stay, readmission, and in-hospital and 1-year mortalities were measured and compared between the two groups. RESULTS: A higher number of patients in the study group had concomitant cardiovascular (p = 0.006) and endocrinologic (p = 0.004) diseases, received perioperative transfusion (p = 0.003), and were admitted to ICU postoperatively (p = 0.014). However, there were no significant differences in postoperative Hb and Hct levels, EBL, length of hospital stay, and the incidences of VTE and delirium between the two groups. In addition, in-hospital and 1-year mortalities as well as postoperative complications showed no significant differences between both groups. CONCLUSIONS: CMN can be performed without delay in elderly patients with proximal femoral fracture receiving antiplatelet therapy prior to admission without discontinuing antiplatelets, and is as safe as in patients who are not on antiplatelet medication. However, more caution is required with respect to transfusions and ICU care after surgery in these patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12891-019-2504-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-64348042019-04-08 Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue? Jang, Chul-Young Kwak, Dae-Kyung Kim, Dae-Hwan Lee, Hyung-Min Hwang, Ji-Hyo Yoo, Je-Hyun BMC Musculoskelet Disord Research Article BACKGROUND: Antiplatelet medication has been frequently performed in elderly patients with hip fracture, because of comorbidities. This observational cohort study was to evaluate the effect of continuous perioperative antiplatelet medication on the outcomes after cephalomedullary nailing (CMN) in elderly patients with a proximal femur fracture. METHODS: One hundred and sixty-two consecutive patients aged ≥70 years undergoing CMN for proximal femur fracture between January 2015 and January 2017 were recruited. Of the 162 patients, 47 (study group) taking antiplatelets preoperatively due to comorbidities were compared with 107 (control group) who were not on antiplatelets. 8 patients taking anticoagulant medication were excluded. Postoperative hemoglobin (Hb) and hematocrit (Hct) levels, transfusion amount and estimated blood loss (EBL), occurrence of venous thromboembolism (VTE) and delirium, intensive care unit (ICU) admission, complications, length of hospital stay, readmission, and in-hospital and 1-year mortalities were measured and compared between the two groups. RESULTS: A higher number of patients in the study group had concomitant cardiovascular (p = 0.006) and endocrinologic (p = 0.004) diseases, received perioperative transfusion (p = 0.003), and were admitted to ICU postoperatively (p = 0.014). However, there were no significant differences in postoperative Hb and Hct levels, EBL, length of hospital stay, and the incidences of VTE and delirium between the two groups. In addition, in-hospital and 1-year mortalities as well as postoperative complications showed no significant differences between both groups. CONCLUSIONS: CMN can be performed without delay in elderly patients with proximal femoral fracture receiving antiplatelet therapy prior to admission without discontinuing antiplatelets, and is as safe as in patients who are not on antiplatelet medication. However, more caution is required with respect to transfusions and ICU care after surgery in these patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12891-019-2504-5) contains supplementary material, which is available to authorized users. BioMed Central 2019-03-25 /pmc/articles/PMC6434804/ /pubmed/30909898 http://dx.doi.org/10.1186/s12891-019-2504-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Jang, Chul-Young
Kwak, Dae-Kyung
Kim, Dae-Hwan
Lee, Hyung-Min
Hwang, Ji-Hyo
Yoo, Je-Hyun
Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?
title Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?
title_full Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?
title_fullStr Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?
title_full_unstemmed Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?
title_short Perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?
title_sort perioperative antiplatelet in elderly patients aged over 70 years treated with proximal femur fracture: continue or discontinue?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434804/
https://www.ncbi.nlm.nih.gov/pubmed/30909898
http://dx.doi.org/10.1186/s12891-019-2504-5
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