Search

Resumen Objetivo Revisar el tratamiento perioperatorio de los pacientes con fracturas de cadera y tratamiento concomitante con antiagregantes plaquetarios, asi como analizar las diferencias de mortalidad al ano, y el sangrado perioperatorio segun la pauta de cirugia precoz ( 5 dias). Paralelamente, determinar al ingreso y en el preoperatorio inmediato la agregabilidad plaquetaria en todos los pacientes incluidos en el estudio. Pacientes y metodo Sobre 175 pacientes mayores de 65 anos con fractura de cadera de baja energia se aleatorizaron 3 grupos: antiagregados con cirugia precoz, antiagregados con cirugia demorada, y no antiagregados con cirugia precoz; se recogieron prospectivamente los mismos datos clinicos y analiticos para todos ellos. La agregabilidad plaquetaria se determino mediante un sistema informatizado semicuantitativo basado en la agregometria por impedancia en sangre completa. Resultados El sangrado, los requerimientos transfusionales y los resultados analiticos no mostraron diferencias estadisticamente significativas entre los grupos. Un 59,8% de los pacientes que no referian tomar antiagregantes se encontraban analiticamente antiagregados al ingreso, mientras que un 13,5% de los que tomaban antiagregantes no se encontraban correctamente antiagregados. El analisis multivariante mostro mayor mortalidad a 12 meses para las variables del indice de Barthel bajo previo a la fractura (OR: 0,9-0,9) y numero de transfusiones (OR: 1,1-1,5). La estancia media fue de 4,1 dias mayor en el grupo demorado. Conclusion La pauta de cirugia precoz para los pacientes en tratamiento antiagregante tiene resultados clinicos parecidos a la demorada, pero mejora la eficiencia hospitalaria al reducir la estancia media. La antiagregacion farmacologica referida por el paciente resulto poco concordante con la determinacion de la agregabilidad.

Objective A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery ( 5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study Patients and methods A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. Results Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not have that. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9–0.9) and number of transfusions (OR: 1.1–1.5). The average length of stay was 4.1 days greater in the delayed surgery group. Conclusion Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.

A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (48 h) versus delayed surgery (5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the studyA total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood.Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group.Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.