Johansen Antony, White James, Turk Adrian
Trauma Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
Injury. 2008 Oct;39(10):1188-90. doi: 10.1016/j.injury.2008.03.018. Epub 2008 Jul 24.
It remains unclear whether it is justifiable to delay hip fracture surgery in patients who are taking clopidogrel therapy-to allow the drug's anti-platelet effect to wear off. In a follow-up of 740 consecutive admissions with hip fracture we describe the extent of blood loss and complications in 17 (2.3%) who were taking clopidogrel. The peri-operative fall in haemoglobin was 1.3g/dl (95% CI: 0.4-2.3g/dl) less in the 10 patients in whom the surgeon's policy was for surgery to be delayed for at least 5 days. However, this group also experienced thromboembolic complications that were potentially attributable to this approach. Clopidogrel therapy does have implications for peri-operative blood loss, but hip fracture is a complex and multifactorial condition. We propose an individualised approach to patients taking this increasingly common drug.
对于正在接受氯吡格雷治疗的患者延迟髋部骨折手术以使其抗血小板作用消退是否合理，目前尚不清楚。在对740例连续入院的髋部骨折患者的随访中，我们描述了17例（2.3%）正在服用氯吡格雷患者的失血量和并发症情况。在外科医生的策略是将手术推迟至少5天的10例患者中，围手术期血红蛋白下降幅度少1.3g/dl（95%CI：0.4 - 2.3g/dl）。然而，该组患者也出现了可能归因于这种方法的血栓栓塞并发症。氯吡格雷治疗确实会对围手术期失血产生影响，但髋部骨折是一种复杂的多因素疾病。我们建议对服用这种日益常见药物的患者采取个体化方法。
