Thaler Heinrich Wolfgang, Frisee Florian, Korninger Christian
Trauma Center Meidling, Vienna, Austria.
J Trauma. 2010 Nov;69(5):1217-20; discussion 1221. doi: 10.1097/TA.0b013e3181f4ab6a.
The purpose of our prospective study was to analyze how many patients with hip fractures are on treatment with platelet aggregation inhibitors (aspirin and clopidogrel), how many of these patients have impaired platelet function as measured by the PFA-100, and whether there is an association between perioperative blood loss and either intake of platelet inhibitors or platelet function.
Four hundred sixty-two patients with hip fractures were investigated. Surgery (most commonly dynamic screw fixation and hemiarthroplasty) was performed on day 1.3 (in patients on clopidogrel on day 3). Platelet function analysis was performed with the PFA-100, using the collagen and epinephrine closure time. Transfusion requirement and drain blood loss were measured.
Ninety-eight patients (21%) were on treatment with aspirin, of those, 64 patients (65%) had impaired platelet function. Twenty-two patients (5%) were on clopidogrel, of those, 15 patients (68%) had impaired platelet function. Of the patients without platelet aggregation inhibitors, 29% had impaired platelet function. Mortality, major bleeding, red blood cell requirement, and drainage blood loss did not correlate with platelet aggregation inhibitor intake or platelet function.
It is not possible to predict the platelet function by asking patients about intake of aspirin or clopidogrel. Perioperative blood loss did not correlate with either history of platelet aggregation inhibitor intake or platelet function as determined by PFA-100. Therefore, the measurement of platelet function is of little clinical relevance in patients with hip fractures. In patients treated with aspirin, surgery should not be delayed, and patients on clopidogrel can be operated on 3 days after stopping the drug without increased bleeding risk.
我们这项前瞻性研究的目的是分析有多少髋部骨折患者正在接受血小板聚集抑制剂（阿司匹林和氯吡格雷）治疗，通过血小板功能分析仪（PFA - 100）测定这些患者中有多少人的血小板功能受损，以及围手术期失血与血小板抑制剂的摄入或血小板功能之间是否存在关联。
对462例髋部骨折患者进行了调查。手术（最常见的是动力髋螺钉固定和半髋关节置换术）在第1.3天进行（服用氯吡格雷的患者在第3天手术）。使用胶原和肾上腺素封闭时间，通过血小板功能分析仪（PFA - 100）进行血小板功能分析。测量输血需求和引流失血量。
98例患者（21%）正在接受阿司匹林治疗，其中64例患者（65%）血小板功能受损。22例患者（5%）正在服用氯吡格雷，其中15例患者（68%）血小板功能受损。在未服用血小板聚集抑制剂的患者中，29%的患者血小板功能受损。死亡率、大出血、红细胞需求量和引流失血量与血小板聚集抑制剂的摄入或血小板功能无关。
通过询问患者是否服用阿司匹林或氯吡格雷来预测血小板功能是不可能的。围手术期失血与血小板聚集抑制剂的摄入史或通过血小板功能分析仪（PFA - 100）测定的血小板功能均无关联。因此，在髋部骨折患者中，血小板功能的测定几乎没有临床意义。对于服用阿司匹林的患者，手术不应延迟，服用氯吡格雷的患者在停药3天后可以进行手术，且不会增加出血风险。
