Early surgical intervention is safe for patients on anti-platelet medication

All patients had non-elective orthopedic surgery and a surgical delay of less than 5 days.

DENVER — New research suggests that early surgical intervention is safe for patients taking anti-platelet medication at admission and who undergo non-elective orthopedic surgery.

In a retrospective study of patients requiring non-elective orthopedic surgery, lead investigator Eric D. Farrell, MD, and colleagues compared the outcomes of 24 patients who were on clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi Pharmaceuticals) at admission with an age- and injury-matched control group of 29 patients. Both groups had a surgical delay of less than 5 days.

Although the investigators discovered a significantly higher preoperative hemoglobin level in the control group compared to the clopidogrel group, they found no statistically significant differences between the groups regarding postoperative hemoglobin levels and rates for transfusion, overall postoperative complications and 30-day mortality.

“There were no serious wound complications in the Plavix group that required surgical intervention,” study co-author Jason A. Nydick, DO, said. “Postoperative hemoglobin, transfusion requirements and 30-day mortality revealed no statistical difference between the Plavix and the control groups. We believe that patients admitted on Plavix can safely undergo early operative intervention and minimize the risk of operative delay.”

Nydick presented the study at the 24th Annual Meeting of the Orthopaedic Trauma Association.

Surgical delay

The investigators used a trauma registry from two university-affiliated teaching institutions to identify patients. The original study groups consisted of 25 patients who were taking clopidogrel with a mean age of 79 years and 32 control patients with an average age of 82 years. The investigators stratified the groups based on a surgical delay of 5 days.

“We did not further evaluate patients with surgical delay greater than 5 days due to our limited numbers,” Nydick said.

Patients in the clopidogrel group had a mean surgical delay of 1.88 days compared to 1.68 days for the control group. Most of the patients in the study underwent surgery for hip fracture.

Morbidity, mortality

“We only found a statistical significance in the preoperative hemoglobin levels,” Nydick said. The clopidogrel group demonstrated a preoperative hemoglobin level of 12.3 g/dL, while the control group had a level of 11.2 g/dL. However, the investigators found no significant differences between the groups’ levels during the first 4 postoperative days.

The study also revealed similar transfusion rates between the groups. In the clopidogrel group, 16 patients required a transfusion compared to 13 patients in the control group.

“We also found no statistical difference in postoperative complications between the two groups,” Nydick said. The investigators found that eight patients in the clopidogrel group had postoperative complications compared to nine patients in the comparison group.

Both groups had two patients who had postoperative wound drainage, and each group had a patient who underwent revision for nonunion. The only mortality in the study occurred in the control group.

“Our study limitations include the small number of patients and the retrospective nature of our study,” he said.

For more information:
Jason A. Nydick, DO, PGY4 orthopedics resident, Philadelphia College of Osteopathic medicine, can be reached at Cooper University Hospital, Three Cooper Plaza, Suite 403, Camden, NJ 08103; 856-342-3321; e-mail: jason31878@yahoo.com. He has no direct financial interest in any products or companies mentioned in this article.

Reference:
Nydick JA, Farrell ED, Marcantonio AJ, Ostrum R, et al. The use of clopidogrel (Plavix) in patients undergoing non-elective orthopedic surgery. Paper #41. Presented at the 24th Annual Meeting of the Orthopaedic Trauma Association. Oct. 16-18, 2008. Denver.