Safety of Early Surgery in Hip Fracture Patients Taking Clopidogrel and/or Aspirin: A Systematic Review and Meta-Analysis

Background: Surgical treatment is generally recommended within 24 to 48 hours after hip fracture. Patients taking antiplatelet drugs such as clopidogrel and aspirin are advised to discontinue them before invasive surgery. However, whether early surgery is feasible remains inconclusive. The aim of this study was to investigate the safety of early surgery in hip fracture patients who took clopidogrel and/or aspirin.

Methods: A systematic search was conducted using databases, including PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science, for studies relating to early arthroplasty or internal fixation for femoral neck fractures (FNF), intertrochanteric fractures (ITF), and subtrochanteric fractures (STF) in patients taking clopidogrel and/or aspirin. A total of 20 observational studies involving 3,077 patients were included in this meta-analysis, and analyzed in groups of early surgery versus delayed surgery, and clopidogrel and/or aspirin versus non-antiplatelet agents.

Results: Patients in the clopidogrel and/or aspirin group who underwent early surgery had significantly more intraoperative blood loss than those in the non-antiplatelet group (Mean Difference (MD) =17.96, 95% confidence interval (CI) [4.37, 31.55], P=0.01), and patients in the clopidogrel and/or aspirin group had a lower overall incidence of complications after early surgery than those in the delayed surgery group (Odds Ratio (OR)=0.26, 95%CI [0.14, 0.29], P<.001) and a shorter length of hospital stay (OR=0.26, 95%CI [0.14, 0.29], P<.001). There was no significant difference in postoperative mortality and other related indicators.

Conclusion: Early surgery in hip fracture patients taking clopidogrel and/or aspirin appears to be safe based on the available evidence and needs to be clarified by higher quality studies. However, the increased risk of cardiovascular events associated with discontinuation of clopidogrel or clopidogrel combined with aspirin dual antiplatelet therapy requires attention in the perioperative period.