Factors Influencing Mortality in Patients on Antiplatelet Agents Presenting with Proximal Femoral Fractures

Abstract

Purpose. To identify factors predicting one-year mortality in patients on clopidogrel presenting with proximal femoral fractures. Methods. 9 men and 22 women aged 64 to 97 (mean, 81; standard deviation, 8) years who had been taking clopidogrel for ischaemic heart disease (n=15), cerebrovascular disease (n=6), or both (n=10) presented with proximal femoral fractures. The time from injury to operation, type of anaesthesia, treatment method, and postoperative complications were reviewed. One-year mortality was analysed using the Kaplan-Meier curve. Factors predicting one-year mortality were identified. Results. The fracture configurations of the 31 patients included intracapsular femoral neck fracture (n=17), intertrochanteric fracture (n=13), and subtrochanteric fracture (n=1). 30 of the patients underwent hemiarthroplasty (n=16), dynamic hip screw fixation (n=9) or intramedullary hip screw fixation (n=5). The remaining patient underwent conservative treatment owing to metastatic prostate cancer. Of the 30 patients who underwent surgery, clopidogrel was discontinued at least 7 days prior to surgery, with the mean delay to surgery being 8.4 (range, 2–16) days. No patient had excessive blood loss at operation, although 7 patients received a blood transfusion postoperatively. 13 (43%) patients developed postoperative complications. The one-year mortality was 26% (8/31). Univariate analysis showed that factors predicting one-year mortality were spinal anaesthesia (p=0.04), postoperative blood transfusion (p=0.03), postoperative complications (p=0.03), and delay to surgery (p=0.03). Multiple regression analysis showed that delay to surgery (p=0.03) was the only independent predictor of one-year mortality, with a hazard ratio of 1.357 (95% confidence interval, 1.03–1.79). Conclusion. Surgery should be performed as soon as possible in medically fit patients having proximal femoral fractures who are taking clopidogrel, as delay to surgery is associated with increased one-year mortality.