Clopidogrel and Hip Fractures, Is It Safe?

A Systematic Review and Meta-Analysis

Christopher G. K. M. Soo; Paul K. Della Torre; Tristan J. Yolland; Michael A. Shatwell


BMC Musculoskelet Disord. 2016;17(136) 

In This Article


The combination of increasing population age, the increasing use of clopidogrel and the increasing number of hip fracture hospital admissions creates an important issue and potential management concern for orthopaedic surgeons. There is a relatively large collection of low-quality evidence showing operating early on neck of femur fracture patients on clopidogrel to be safe. However there is still wide variation in clinical practice and no consensus on recommendations.

The aim of this paper was to gather the best evidence available on the effect of clopidogrel on hip fracture surgery patients. Most of the literature is made up of low quality retrospective non-randomised cohort studies with small sample sizes. Ultimately, large multi-centred, adequately powered, well-designed randomised trials are needed to establish clearer guidelines for the management of these patients.

On the available evidence, we recommend that these patients can be managed by normal protocols with early surgery. Operating early on patients on clopidogrel is safe and does not appear to confer any clinically significant bleeding risk. As reported in other studies, we believe clopidogrel, if possible, should not be withheld throughout the perioperative period due to an increased risk of cardiovascular events associated with stopping clopidogrel. Care should be taken intraoperatively to minimise blood loss due to the increased potential for bleeding.