Platelet aggregometry for hip fracture surgery in patients treated with clopidogrel: a pilot study

• Published in: Journal of clinical monitoring and computing 2022-06, Vol.36 (3), p.823-828
• Main Authors: Tescione, Marco, Vadalà, Eugenio, Marano, Graziella, Battaglia, Enzo, Bruni, Andrea, Garofalo, Eugenio, Longhini, Federico, Rovida, Serena, Polimeni, Nicola, Squillaci, Rosalba, Lascala, Stefano, Franco, Gaetana, Labate, Demetrio, Caracciolo, Massimo, Macheda, Sebastiano
• Format: Article
• Language: English
• Subjects: Agglomeration; Anesthesia; Anesthesiology; Critical Care Medicine; Fractures; General anesthesia; Health Sciences; Intensive; Medicine; Medicine & Public Health; Mortality; Original Research; Parameters; Patients; Platelets; Risk assessment; Statistics for Life Sciences; Surgery
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-021-00714-z

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)