抗血小板薬内服中の大腿骨頚部骨折患者に対する人工骨頭挿入術の検討

抄録

Objective: Early operation is considered to have a better outcome for elderly patients with hip fractures. However, elderly patients are often managed on long-term antiplatelet agents/anticoagulant therapy. Therefore, such patients may be at increased risk of perioperative bleeding and other complications. The aim of this study was to evaluate the safety of hemiarthroplasty for hip fracture in patients taking antiplatelet drugs (APDs).

Methods: A retrospective chart review was conducted. Thirty-one patients taking APDs underwent hemiarthroplasty for hip fractures in our hospital between January 2014 and December 2015. All patients had APDs discontinued after admission until two days post-surgery. Patients were divided into two groups, an ‘early’ group (surgical delay<5 days after admission) or a ‘delay’ group (surgical delay>4 days after admission). We investigated the patients’ hemoglobin (Hb) levels, walking ability, the length of hospitalization, postoperative complications and transfusions associated with APDs.

Results: There was no significant difference with postoperative Hb level and the amount of transfusion between the two groups. There were also no complications related to spinal anesthesia between the two groups. The ‘early’ group had better walking ability (P=0.045) and shorter hospitalization in 9 days (P=0.024) compared to the ‘delay’ group. The ‘delay’ group significantly increased in the risk of postoperative complications than the ‘early’ group (P=0.003).

Conclusion: There was no significant difference in perioperative bleeding after early hemiarthroplasty in patients taking APDs with hip fractures. Therefore, this study demonstrates that early operation for hip fractures is safe and, in doing so, there may be better outcomes for patients taking such medications.