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Current Issue - March 2023, Volume 17, Issue No. 1

Official Journal of Malaysian Orthopaedic Association and ASEAN Orthopaedic Association

The Effect of Pre-operative use of Antiplatelets and Anticoagulants on Time to Surgery in Hip Fracture Patients


Introduction: Hip fractures are a major health concern resulting in significant morbidity worldwide. They are the leading cause of fall-related injuries amongst the elderly with high risk of death, and numbers are expected to rise with the growing elderly population. Expedited surgical repair has been proven to improve patient outcomes, however there are often multiple barriers to early surgery especially in the elderly. The use of antiplatelets and anticoagulation is a significant contributory factor to surgical delay.

Materials and methods: We conducted a retrospective, single centre study on hip fracture patients admitted to an acute care orthogeriatric unit over a 12-month period, aimed at determining the impact of pre-operative use of antiplatelets and anticoagulants on time to surgery (TTS) and its impact on one-year mortality rates.

Results: Amongst 404 eligible patients, 102 were on antiplatelets, 23 on anticoagulants and 279 were neither on antiplatelets or anticoagulants. Our study showed that patients taking clopidogrel (p<0.001) and DOACs (p=0.001) were more likely to have delayed surgery compared to those who were not on these agents. In addition, all patients on warfarin experienced surgical delay. Warfarin group also had highest mortality rates compared to other group and 10 times more likely to die within a year (p=0.001).

Conclusion: The results from this study are consistent with existing literature, suggesting that the use of clopidogrel and anticoagulants have a negative impact on TTS in hip fracture patients. Strategies should be developed for patients on these medications to enhance their TTS.

Abstract   |   Reference

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The Malaysian Orthopaedic Journal is a peer-reviewed journal that is published three times a year in both print and electronic online version. The purpose of this journal is to publish original research studies, evaluation of current practices and case reports in various subspecialties of orthopaedics and traumatology, as well as associated fields like basic science, biomedical engineering, rehabilitation medicine and nursing.

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