Limited evidence supports not delaying hip fracture surgery for patients on aspirin and/or clopidogrel.

Management of Hip Fractures in the Elderly
Endorsed by: OTA, AGS, AAPM&R, ASBMR, USBJI, The Hip Society, AACE, ORA
Limited Evidence LIMITED EVIDENCE
Rationale
Six low-strength studies (Chechik et al34; Maheshwari et al 35; Manning et al 36; Thaler et al 37; Hossain et al 38) showed either no difference in outcome or favored not delaying hip fracture surgery in patients on antiplatelet (clopidogrel and/or aspirin) therapy. Previously, some surgeons have delayed surgery for hip fracture patients on Aspirin and / or clopidogrel. This systematic review suggests at worse that there is no advantage to this practice or that in fact the advantage is for patients where surgery is not delayed. The benefit of implementing this recommendation is preventing an unnecessary (unhelpful) delay in performing hip fracture surgery.
 
Risks and Harms of Implementing this Recommendation
As with all surgical procedures, there are potential risks and complications, including, but not limited to, the possibility of bleeding. There is no data suggesting patient outcome harms will occur with implementation of this recommendation.
 
Future Research
Future research with regard to risks and benefits of delayed surgery should include patient oriented outcome measures such as death, return to prior living situation and treatment complications such as transfusions, wound infections and return to operating room. Some of these factors may be addressed with treatment registries. It is also appropriate to address the risks and benefits of delayed surgery for patients on antiplatelet medication specific to this patient population and to quantify risks of those who are on these medicines (e.g. bleeding, transfusions, etc). Appropriately targeted randomized trials would be helpful.
 
  1. (34) Chechik O, Amar E, Khashan M, Kadar A, Rosenblatt Y, Maman E. In support of early surgery for hip fractures sustained by elderly patients taking clopidogrel: a retrospective study. Drugs Aging 2012;29(1):63-68.
  2. (35) Maheshwari R, Acharya M, Monda M, Pandey R. Factors influencing mortality in patients on antiplatelet agents presenting with proximal femoral fractures. J Orthop Surg (Hong Kong) 2011;19(3):314-316.
  3. (36) Manning BJ, O'Brien N, Aravindan S, Cahill RA, McGreal G, Redmond HP. The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures. Injury 2004;35(2):121-124.
  4. (37) Thaler HW, Frisee F, Korninger C. Platelet aggregation inhibitors, platelet function testing, and blood loss in hip fracture surgery. J Trauma 2010;69(5):1217-1220.
  5. (38) Hossain FS, Rambani R, Ribee H, Koch L. Is discontinuation of clopidogrel necessary for intracapsular hip fracture surgery? Analysis of 102 hemiarthroplasties. J Orthop Traumatol 2013.