Key result
Early osteosynthetic surgery (<24 hours) in patients on antiplatelet therapy resulted in higher total blood loss compared to no antiplatelet therapy (1780 mL vs 1493 mL, p<0.05), but did not increase transfusion needs and was associated with lower mortality.
Why the study?
Guidelines recommend 5-7 days of antiplatelet interruption for elective surgery, but early osteosynthetic surgery of proximal femoral fractures despite antiplatelet therapy may be warranted.
Does early osteosynthetic surgery despite antiplatelet therapy increase blood loss, complications, and mortality in patients with proximal femoral fractures?
Cohort (n=396)
No
Does early osteosynthetic surgery despite antiplatelet therapy increase blood loss, complications, and mortality in patients with proximal femoral fractures?
Early surgery for proximal femoral fractures can be safely performed in patients on antiplatelet therapy without increasing the need for transfusions or major bleeding complications, while reducing mortality and hospital stay.
Answers are grounded in this paper and cite their sources.
Early surgery in antiplatelet patients may avoid excess transfusions despite higher blood loss; leaves open mortality benefit in prospective trials.
BACKGROUND: Proximal femoral fractures should be treated in a timely manner. Affected patients often require antiplatelet therapy (APT) due to cardiovascular diseases. Guidelines recommend 5-7 days APT interruption for elective surgery. Early osteosynthetic surgery of proximal femoral fractures despite of APT should be considered. AIM OF THE STUDY: To evaluate whether early osteosynthetic surgery despite of APT is associated with increased blood loss, complications and mortality. METHODS: Data of patients with proximal femoral fractures, who were treated by osteosynthesis at the Department of Trauma Surgery at the Medical University of Vienna were collected retrospectively. Study groups were formed by time to surgery and APT interruption. The primary endpoint of the study was the perioperative blood loss. Secondary endpoints were complications, 30-day and 1-year mortality, time to surgery, and the total length of hospital stay. RESULTS: The osteosynthetic treatment of proximal femoral fractures despite of APT resulted in a shorter time to surgery (13.8 vs. 66.0 h; p < 0.01). In patients on APT, the TBL (total perioperative blood loss) was higher without need for revision or an increase in the need for packed red blood cells if surgery was performed within 24 h after admission. APT had no significant influence on mortality. Patients who underwent surgery within 24 h after admission had a lower mortality. The complication rate was higher in patients who underwent surgery later than 24 h after admission. CONCLUSIONS: Surgery within 24 h after admission, regardless of APT, resulted in a shorter hospitalization length and was associated with less common complications and a lower mortality.
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Humenberger et al. (2019) conducted a cohort in Proximal femoral fractures (n=396). Antiplatelet therapy (APT) vs. No antiplatelet therapy was evaluated on Total perioperative blood loss (TBL) for surgery <24h (p=<0.05). Early osteosynthetic surgery (<24 hours) in patients on antiplatelet therapy resulted in higher total blood loss compared to no antiplatelet therapy (1780 mL vs 1493 mL, p<0.05), but did not increase transfusion needs and was associated with lower mortality.
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