Early Surgery with Neuraxial Anaesthesia in Patients on Chronic Antiplatelet Therapy with a Proximal Femur Fracture: Multicentric Randomised Clinical Trial

Background: Patients with proximal femur fracture on antiplatelet treatment benefit from early surgery. Our goal was to perform early surgery under neuraxial anaesthesia when indicated by the platelet function test. Methods: We conducted a multicentre randomised open-label parallel clinical trial. Patients were randomised to either early platelet function-guided surgery (experimental group) or delayed surgery (control group). Early surgery was programmed when the functional platelet count (as measured by Plateletworks) was >80 × 109/L. The primary outcome was the emergency admission-to-surgery interval. Secondary outcomes were platelet function, postoperative bleeding, medical and surgical complications, and mortality. Results: A total of 156 patients were randomised, with 78 in each group, with a mean (SD) age of 85.96 (7.9) years, and 67.8% being female. The median (IQR) time to surgery was 2.3 (1.5–3.7) days for the experimental group and 4.9 (4.4–5.6) days for the control group. One-third of patients did not achieve the threshold functional platelet count on the first day of admission, requiring more than one test. There was no difference in clinical outcomes between groups. Conclusions: A strategy individualised according to the platelet function test shortens the time to proximal femur fracture surgery under neuraxial anaesthesia in patients on chronic antiplatelet treatment. Better powered randomised clinical trials are needed to further evaluate the clinical impact and safety of this strategy.

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Application of Platelet Function Test in Prevention of Ischemic Stroke After Stent Placement in Intracranial Aneurysms

Case Medical Research ◽

10.31525/ct1-nct03989557 ◽

2019 ◽

Author(s):

Keyword(s):

Ischemic Stroke ◽

Platelet Function ◽

Stent Placement ◽

Intracranial Aneurysms ◽

Platelet Function Test ◽

Function Test

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Mortality Rates of Proximal Femur Fracture Patients Through a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study

SSRN Electronic Journal ◽

10.2139/ssrn.3576799 ◽

2020 ◽

Author(s):

Josep Maria Muñoz Vives ◽

Montsant Jornet-Gibert ◽

J. Cámara-Cabrera ◽

Pedro L. Esteban ◽

Laia Brunet ◽

...

Keyword(s):

Observational Study ◽

Proximal Femur ◽

Femur Fracture ◽

Mortality Rates ◽

Proximal Femur Fracture ◽

Preliminary Results

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Patient Positioning for Proximal Femur Fracture Fixation: a Review of Best Practices

Current Reviews in Musculoskeletal Medicine ◽

10.1007/s12178-021-09710-x ◽

2021 ◽

Author(s):

Khushdeep S. Vig ◽

Curtis Adams ◽

Joseph R. Young ◽

Eric Perloff ◽

Casey M. O’Connor ◽

...

Keyword(s):

Best Practices ◽

Proximal Femur ◽

Fracture Fixation ◽

Femur Fracture ◽

Patient Positioning ◽

Proximal Femur Fracture

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Early mortality in hip fracture patients admitted during first wave of the COVID-19 pandemic in Northern Italy: a multicentre study

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00577-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Dante Dallari ◽

Luigi Zagra ◽

Pietro Cimatti ◽

Nicola Guindani ◽

Rocco D’Apolito ◽

...

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Multicentre Study ◽

Proximal Femur ◽

Femur Fracture ◽

Northern Italy ◽

Proximal Femur Fracture ◽

Time To Surgery ◽

Fracture Management ◽

The Mean

Abstract Background Treatment of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. The primary endpoint of this study is to compare the mortality rate at 1 month after surgery in symptomatic COVID-positive patients with that of asymptomatic patients. A secondary endpoint of the study is to evaluate, in the two groups of patients, mortality at 1 month on the basis of type of fracture and type of surgical treatment. Materials and methods For this retrospective multicentre study, we reviewed the medical records of patients hospitalised for proximal femur fracture at 14 hospitals in Northern Italy. Two groups were formed: COVID-19-positive patients (C+ group) presented symptoms, had a positive swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and received treatment for COVID-19; COVID-19-negative patients (C− group) were asymptomatic and tested negative for SARS-CoV-2. The two groups were compared for differences in time to surgery, survival rate and complications rate. The follow-up period was 1 month. Results Of the 1390 patients admitted for acute care for any reason, 477 had a proximal femur fracture; 53 were C+ but only 12/53 were diagnosed as such at admission. The mean age was > 80 years, and the mean American Society of Anesthesiologists (ASA) score was 3 in both groups. There was no substantial difference in time to surgery (on average, 2.3 days for the C+ group and 2.8 for the C− group). As expected, a higher mortality rate was recorded for the C+ group but not associated with the type of hip fracture or treatment. No correlation was found between early treatment (< 48 h to surgery) and better outcome in the C+ group. Conclusions Hip fracture in COVID-19-positive patients accounted for 11% of the total. On average, the time to surgery was > 48 h, which reflects the difficulty of maintaining normal workflow during a medical emergency such as the present pandemic and notwithstanding the suspension of non-urgent procedures. Hip fracture was associated with a higher 30-day mortality rate in COVID-19-positive patients than in COVID-19-negative patients. This fact should be considered when communicating with patients and/or their family. Our data suggest no substantial difference in hip fracture management between patients with or without COVID-19 infection. In this sample, the COVID-19-positive patients were generally asymptomatic at admission; therefore, routine screening is recommended. Level of evidence Therapeutic study, level 4.

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