Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
J Clin Monit Comput. 2022 Jun;36(3):823-828. doi: 10.1007/s10877-021-00714-z. Epub 2021 May 6.
Surgery for hip fractures should be performed within 48 h from patient's admission. However, several factors including chronic antiplatelet therapy could delay operation. Among the totality of patients taking clopidogrel, up to 30% are resistant to the drug and have a normal platelets reactivity. We propose thromboelastography (TEG) with an ADP Platelet Mapping assay kit to assess platelet aggregation, a safe tool that could help to avoid surgery delay in those patients treated with antiplatelet therapy. A patient's blood sample was collected for aggregometry. If MA-ADP and platelets aggregation (%) were within normal values, the patient was fit for immediate surgery with neuraxial anesthesia and ultrasound-guided nerve block. If one of the two parameters or both were deranged, a mortality risk assessment was estimated. In the low risk category, the patients waited till normalization of the parameters, whereas in the high-risk group a general anesthesia and peripheral antalgic block was carried out. Nine patients were enrolled. Four of them showed normal aggregometry and surgery was performed within 24 h from admission. Two patients were classified as high mortality risk and surgery was carried out under general anesthesia. Three patients awaited operation till normalization of parameters. No peri or post-operative complications were reported. An aggregometry-guided protocol can safely expedite hip fracture surgery in patients taking clopidogrel. Nonetheless, in presence of a normal platelets function, clinician can opt for a neuraxial instead of general anesthesia reducing the incidence of postoperative delirium and cognitive dysfunction.Trial registration: prospectively registered at clinicaltrials.gov (NCT04642209; date of registration: 23rd November 2020).
髋部骨折患者应在入院后 48 小时内进行手术。然而，一些因素，包括慢性抗血小板治疗，可能会延迟手术。在服用氯吡格雷的所有患者中，高达 30%的患者对该药物有耐药性，血小板反应正常。我们建议使用血栓弹力图（TEG）和 ADP 血小板图谱检测试剂盒来评估血小板聚集，这是一种安全的工具，可以帮助避免接受抗血小板治疗的患者手术延迟。采集患者的血液样本进行聚集度检测。如果 MA-ADP 和血小板聚集（%）值在正常范围内，患者适合立即进行神经轴麻醉和超声引导的神经阻滞手术。如果这两个参数中的一个或两个参数异常，则进行死亡率风险评估。在低危类别中，患者等待参数恢复正常，而在高危组中，进行全身麻醉和外周止痛阻滞。共纳入 9 例患者。其中 4 例聚集度正常，在入院后 24 小时内进行了手术。2 例患者被归类为高死亡率风险，进行全身麻醉手术。3 例患者等待参数恢复正常后再进行手术。未报告围手术期或术后并发症。血小板聚集检测指导的方案可安全地加速服用氯吡格雷的髋部骨折患者的手术。然而，在血小板功能正常的情况下，临床医生可以选择神经轴麻醉而不是全身麻醉，从而降低术后谵妄和认知功能障碍的发生率。试验注册：前瞻性在 clinicaltrials.gov 注册（NCT04642209；注册日期：2020 年 11 月 23 日）。
