Bleeding and First-year Mortality Following Hip Fracture Surgery and Preoperative Use of Low-dose Acetylsalicylic Acid

An Observational Cohort Study

Annika M Kragh; Markus Waldén; Anna Apelqvist; Philippe Wagner; Isam Atroshi

Disclosures

BMC Musculoskelet Disord. 2011;12(254) 

In This Article

Background

Hip fracture is common in elderly people and these patients have a more than doubled mortality risk compared to that of an age-matched non-fracture population.[1] Large studies have reported 30-day mortality of 6% to 11% and a 90-day mortality of up to 20%.[2,3] The causes of the high mortality are not fully known and although comorbidities, including cardiovascular disease, have been suggested to at least partly explain the increased mortality, other factors may be involved.[4,5] Since antiplatelet drugs and anticoagulants are increasingly used for primary and secondary prevention in cardiovascular disease, a large proportion of patients admitted for hip fracture are on such treatment, mainly low-dose acetylsalicylic acid (LdAA). Recent studies have recommended the continuation over surgery for many of these agents with the exception of warfarin and other vitamin K antagonists.[6–8] The rationale for not discontinuing LdAA prior to emergency fracture surgery is its irreversible inhibition of platelet function for the platelets' entire life span (8 to 10 days). However, possible association between preoperative anti-platelet therapy, specifically LdAA, and mortality following hip fracture has not previously been ascertained. We performed a randomized controlled trial to assess the efficacy of a pneumatic compression bandage, applied to the hip immediately after hip fracture surgery, in reducing the need for blood transfusion and found that the bandage did not reduce the proportion of transfused patients or the amount of transfusion.[9] In this observational study of the trial participants we analyzed intraoperative blood loss, transfusions, postoperative complications and first-year all-cause mortality after surgery. Our hypothesis was that patients using LdAA before the hip fracture had higher need for blood transfusions and higher first-year mortality than those not using LdAA at the time of hip fracture.

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