Fractura de cadera, antiagregantes plaquetarios y complicaciones postoperatorias

Resumen

Objetivos

Evaluar la incidencia de complicaciones postoperatorias, de transfusiones sanguíneas y supervivencia al mes, en los pacientes mayores intervenidos de fractura de cadera y que estaban en tratamiento crónico con antiagregantes plaquetarios.

Material y métodos

Se estudiaron retrospectivamente 223 pacientes intervenidos de fractura de fémur. Se estratificaron en 3 grupos: pacientes que no tomaban antiagregantes (grupo I), pacientes que tomaban ácido acetilsalicílico 100 mg/día o triflusal 300 mg/día (grupo II) y pacientes que tomaban ácido acetilsalicílico > 100 mg/día, triflusal > 300 mg/día o tienopiridinas (grupo III). En los pacientes del grupo III se demoró la cirugía 4 días. Se registraron características demográficas, biológicas, clínicas, de tratamiento, complicaciones postoperatorias y supervivencia al mes.

Resultados

Los pacientes del grupo III tuvieron mayor edad y peor estado general de salud. Los pacientes con mayor requerimiento transfusional fueron los del grupo II (73,8%) (p = 0,192), que además presentaron un mayor porcentaje de anemia al ingreso. Tuvieron complicaciones cardiocirculatorias graves un 5,4% de los pacientes del grupo III, un 4,8% del grupo II y un 2,1% del grupo I. Los pacientes del grupo III presentaron un aumento estadísticamente significativo de las complicaciones respiratorias (p = 0,007).

Conclusiones

Los resultados de nuestro estudio evidencian que demorar la cirugía 4 días en los pacientes tratados con clopidogrel puede estar asociado a un incremento de las complicaciones postoperatorias respiratorias y del riesgo de eventos cardiovasculares graves, sin aumentar el índice transfusional, la estancia hospitalaria, la mortalidad, y sin complicaciones relacionadas con la anestesia neuroaxial.

Abstract

Objectives

To assess the incidence of postoperative complications, blood transfusions and survival at one month, in the old patients operated for hip fracture undergoing chronic treatment with antiplatelet drugs.

Material and methods

Two hundred twenty three patients operated for hip fracture were studied retrospectively, separated into 3 groups: patients who received acetylsalicylic acid (group I), patients who were given 100 mg/day of acetylsalicylic acid or 300 mg/day of triflusal (group II) and patients receiving > 100 mg/day of acetylsalicylic acid, or > 300 mg/day of triflusal or thienopyridines (group III). Surgery was delayed for 4 days in patients in group III. Demographic, biological, clinical and treatment characteristics, postoperative complications and survival at one month were recorded.

Results

Patients in group III were older and sustain worse general health status. Patients with a higher transfusion requirement were those of group II (73.8%) (P=0.192), who also showed a higher percentage of anaemia on admission. Severe cardiovascular complications were experienced by 5.4% of group III patients, 4.8% of group II patients and 2.1% of group I patients. Patients from group III presented a significant amount of respiratory complications (P=0.007).

Conclusions

Our results suggest that delaying surgery for 4 days in patients treated with clopidogrel can be associated to an increase in postoperative respiratory complications and severe adverse cardiovascular events, without increasing the tranfusional index, hospital stay, mortality, and without complications related to neuraxial anaesthesia.