Clopidogrel therapy--implications for hip fracture surgery.

It remains unclear whether it is justifiable to delay hip fracture surgery in patients who are taking clopidogrel therapy-to allow the drug's anti-platelet effect to wear off. In a follow-up of 740 consecutive admissions with hip fracture we describe the extent of blood loss and complications in 17 (2.3%) who were taking clopidogrel. The peri-operative fall in haemoglobin was 1.3g/dl (95% CI: 0.4-2.3g/dl) less in the 10 patients in whom the surgeon's policy was for surgery to be delayed for at least 5 days. However, this group also experienced thromboembolic complications that were potentially attributable to this approach. Clopidogrel therapy does have implications for peri-operative blood loss, but hip fracture is a complex and multifactorial condition. We propose an individualised approach to patients taking this increasingly common drug.