Lin Sung-Yen, Huang Hsuan-Ti, Chou Shih-Hsiang, Ho Cheng-Jung, Liu Zi-Miao, Chen Chung-Hwan, Lu Cheng-Chang
Orthopedics. 2019 Sep 1;42(5):268-274. doi: 10.3928/01477447-20190723-02. Epub 2019 Jul 29.
Elderly patients with hip fractures who are receiving antiplatelet therapy are commonly encountered in clinical practice. This study sought to elucidate the safety of urgent hip surgery without termination of antiplatelet medication among patients taking a combination of aspirin and dipyridamole, aspirin alone, or dipyridamole alone. This retrospective cohort study included 176 patients 55 years or older who had uncomplicated hip fractures and underwent surgery within 48 hours after admission. On the basis of the preoperative medication regimen, the patients were divided into the following 4 groups: those receiving aspirin and dipyridamole combined (n=29); those receiving aspirin alone (n=63); those receiving dipyridamole alone (n=28); and those not receiving antiplatelet medication (n=56). Main outcomes, including total blood loss, transfusion rate, and 1-year mortality, were analyzed. There was no significant difference in total blood loss, transfusion rate, or 1-year mortality among the 4 groups. The group receiving aspirin and dipyridamole combined preoperatively had increased intraoperative blood loss (mean, 309.14±189.15 mL) compared with the group not receiving antiplatelet medication (mean, 214.64±119.21 mL; P=.005). There was no significant difference in the hazard ratio (P>.05) for 1-year mortality among the 4 groups after adjusting for confounding covariates, including age, sex, Charlson Comorbidity Index, and duration of hospital stay. Patients receiving antiplatelet medication, including aspirin, dipyridamole, or both, who have uncomplicated hip fractures may undergo urgent surgery without a significant difference in total blood loss, transfusion rate, or 1-year mortality compared with patients not receiving anti-platelet medication. [Orthopedics. 2019; 42(5):268-274.].
临床实践中经常会遇到正在接受抗血小板治疗的老年髋部骨折患者。本研究旨在阐明在服用阿司匹林和双嘧达莫联合制剂、单独服用阿司匹林或单独服用双嘧达莫的患者中，不终止抗血小板药物治疗而进行急诊髋部手术的安全性。这项回顾性队列研究纳入了176例55岁及以上的患者，这些患者患有单纯性髋部骨折且在入院后48小时内接受了手术。根据术前用药方案，将患者分为以下4组：接受阿司匹林和双嘧达莫联合治疗的患者（n = 29）；单独接受阿司匹林治疗的患者（n = 63）；单独接受双嘧达莫治疗的患者（n = 28）；以及未接受抗血小板药物治疗的患者（n = 56）。分析了主要结局，包括总失血量、输血率和1年死亡率。4组之间的总失血量、输血率或1年死亡率无显著差异。与未接受抗血小板药物治疗的组（平均214.64±119.21 mL；P = 0.005）相比，术前接受阿司匹林和双嘧达莫联合治疗的组术中失血量增加（平均309.14±189.15 mL）。在调整了包括年龄、性别、Charlson合并症指数和住院时间等混杂协变量后，4组之间1年死亡率的风险比无显著差异（P>0.05）。与未接受抗血小板药物治疗的患者相比，患有单纯性髋部骨折且接受抗血小板药物治疗（包括阿司匹林、双嘧达莫或两者）的患者可以接受急诊手术，且在总失血量、输血率或1年死亡率方面无显著差异。[《骨科》。2019年；42(5):268 - 274。]
