The Impacts of Early Hip Surgery in High-Risk Elderly Taking Antithrombotic Agents and Afflicted with Intertrochanteric Fracture
Noratep Kulachote MD*, Paphon Sa-Ngasoongsong MD*, Norachart Sirisreetreerux MD*, Siwadol Wongsak MD*, Chanyut Suphachatwong MD*, Wiwat Wajanavisit MD*, Viroj Kawinwonggowit MD*
Affiliation : * Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : To compare the outcome of early hip surgery in intertrochanteric fracture between high surgical risk patients
receiving antiplatelet and anticoagulant drugs and those who did not.
Design : Retrospective study.
Material and Method: One hundred and four elderly patients with intertrochanteric fracture and having American Society of
Anesthesiologist grade III-IV, who underwent early hip surgery (within 72 hours after admission) with proximal femoral nail
anti-rotation (PFNA), were recruited and allocated into two group: antiplatelet and anticoagulant (AA-AC) group (n = 65),
and no drug group (n = 39). Perioperative and postoperative outcomes were recorded and analyzed.
Results : The mean age was 81+8 years. The overall 1-year mortality was 6.7% (7 patients: 5 AA-AC group, and 2 no drug
group, p = 0.7). Intra-operative blood loss in AA-AC group and No drug group were 87+70 and 91+65 ml, respectively (p
= 0.74). There was no significant difference in blood transfusion, postoperative complications, and 1-year ambulatory status
between both groups (p>0.05 all). However, AA-AC group showed significant longer in duration of hospital stay compared
with no drug group (p = 0.02).
Conclusion : Early hip fracture surgery with PFNA in patients who received antiplatelet and anticoagulant medications is safe
and does not significantly increase perioperative blood loss, blood transfusion, and postoperative mortality and morbidity.
Keywords : Trochanteric fracture, Antithrombolic agent, Proximal femoral nail antirotation (PFNA)
