Anti-platelet drugs in patients with femoral neck fractures undergoing cemented hip hemiarthroplasty surgery. A study of complications and mortality

ObjectiveTo assess complications and factors predicting one-year mortality in patients on anti-platelet agents presenting with femoral neck fractures undergoing hip hemiarthroplasty surgery.Material and methodsA review was made on 50 patients on preoperative anti-platelet agents and 83 patients without preoperative anti-platelet agents. Patients in both groups were treated with cemented hip hemiarthroplasty. A statistical comparison was performed using epidemiological data, comorbidities, mental state, complications and mortality. There was no lost to follow-up.ResultsThe one-year mortality was 20.3%. In patients without preoperative anti-platelet agents it was 14.4% and in patients with preoperative anti-platelet agents was 30%. Age, ASA grade, number of comorbidities and anti-platelet agent therapy were predictors of one-year mortality.The one-year mortality of patients on clopidogrel was 46.1%, versus 24.3% in patients on acetylsalicylic acid.ConclusionPatients with preoperative anti-platelet therapy were older and had greater number of comorbidities, ASA grade, delayed surgery, and a longer length of stay than patients without anti-platelet therapy. The one-year mortality was higher in patients with preoperative anti-platelet therapy.

ResumenObjetivoEvaluar las complicaciones y la mortalidad en pacientes antiagregados con fractura cervical desplazada de cadera tratada con prótesis parcial.Material y métodoEstudio de 133 pacientes en el período 2008 a 2010 que se distribuyeron en 2 grupos, con tratamiento antiagregante en el momento del ingreso (50 pacientes) y sin tratamiento antiagregante (83 pacientes). Todos tratados mediante sustitución parcial de cadera con implante de prótesis parcial modular cementada. Se valoraron los datos epidemiológicos, comorbilidades, estado mental, complicaciones y mortalidad. No hubo pérdidas de seguimiento.ResultadosLa mortalidad anual de la serie completa fue del 20,3%; en pacientes no antiagregados, del 14,4%, y en pacientes antiagregados, del 30%. Los predictores de mortalidad a los 12 meses fueron la edad, el grado ASA, el número de comorbilidades asociadas y la antiagregación.Los pacientes antiagregados con clopidogrel tuvieron una mortalidad del 46,1%, frente al 24,3% de los pacientes antiagregados con ácido acetilsalicílico.ConclusionesLos pacientes antiagregados tenían mayor edad, número de comorbilidades, grado ASA, demora quirúrgica y estancia hospitalaria que los no antiagregados. A los 12 meses de la cirugía la mortalidad acumulada ha sido mayor en pacientes antiagregados que en los no antiagregados.