Klopidogrel kullanan kalça kırıklı hastalarda erken cerrahi uygundur

Yıl 2015, , 249 - 254, 17.07.2015

Sinan Zehir , Regayip Zehir , Taner Sarak

https://doi.org/10.3944/AOTT.2015.14.0160

Öz

Amaç: Antiplatelet tedavi alırken kalça kırığı gelişen hastaların cerrahi müdahale zamanlaması tartışmalı bir durumdur. Klopidogrel birçok hastalığın tedavisinde yaygın olarak kullanılan antiplatelet bir ilaçtır. Bu çalışmada klopidogrel tedavisi alırken kalça kırığı olan hastaların cerrahi müdahale sonuçlarını karşılaştırmayı amaçladık.

Çalışma planı: 2009 ile 2014 yılları arasında ileri yaş femur boyun kırığı nedeni ile açık cerrahi uygulanan hastalar geriye dönük olarak tarandı. Çalışmaya 211 hasta dahil edildi. Hastalar; klopidogrel kullanan ve ilk 48 saat içinde opere edilenler (grup 1, 74 hasta), klopidogrel kullanan ve beşinci günden sonra opere edilen (grup 2, 55 hasta) ve herhangi bir antiagregan kullanmayan (grup 3, 82 hasta) olarak üç gruba ayrıldı. Gruplar kan transfüzyon miktarı, yatış süresi, komplikasyon ve mortalite açısından karşılaştırıldı.

Bulgular: Gruplar arasında yaş cinsiyet operasyon öncesi hemoglobin değerleri ve ASA skorları açısından anlamlı fark tespit edilemedi. Birinci gruptaki hastaların daha fazla kan transfüzyonu ihtiyacı oldu (p=0.023). İkinci grupta hastanede kalış süresi daha yüksek idi (p<0.01) ve daha yüksek oranda (%25.4) komplikasyon görüldü (p<0.01). İkinci gruptaki hastalarda ilk otuz gün içinde ve ilk üç ay içinde ölüm oranı diğer gruplara göre daha yüksek bulundu (sırasıyla, p=0.031, p<0.01).

Çıkarımlar: Kalça kırıklarında cerrahi müdahale klopidogrel kullanan hastalarda ertelenmemelidir.

 

 

DOI: 10.3944/AOTT.2015.14.0160

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Anahtar Kelimeler

Klopidogrel; erken cerrahi; kalça kırığı.

Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy

Öz

Objective: Timing of surgery in hip fracture patients using antiplatelet agents is a controversial issue. Clopidogrel is an antiplatelet drug widely used in the treatment of many diseases. In this study, we aimed to investigate the outcomes of early surgery in hip fracture patients using clopidogrel.
Methods: Elderly patients with femoral neck fractures who underwent open surgery between 2009 and 2014 were evaluated. Two hundred and eleven patients were included in the study. Patients were separated into 3 groups. Group 1 was constituted of patients using clopidogrel who had been operated on within 48 h after admission (n=74), Group 2 was constituted of patients using clopidogrel who had been operated on after the fifth day of admission (n=55), and Group 3 was constituted of patients not using clopidogrel who had been operated on within 48 h after admission (n=83). Length of hospital stay, amount of blood transfusion, rate of complication, and mortality rate were assessed for comparison of groups.
Results: Age, sex, preoperative hemoglobin values, and ASA scores were not different between the groups. Amount of blood transfusions was higher in Group 1 (p=0.023). Duration of hospital stay was longer in Group 2 (p<0.01), as was complication rate (25.4%) (p<0.01). Mortality within 30 days and within the first 3 months post-surgery was significantly higher in Group 2 (p=0.031, p<0.01; respectively).
Conclusion: Surgery should not be postponed in hip fracture patients using clopidogrel.

Anahtar Kelimeler

Clopidogrel, early surgery, hip fracture

Kaynakça

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