SynthesisBMC musculoskeletal disorders2016
Clopidogrel and hip fractures, is it safe? A systematic review and meta-analysis.
Synthesis in BMC musculoskeletal disorders, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 63 citations in OpenAlex.
- Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A systematic review and meta-analysis.Journal of orthopaedic surgery and research · 2020Pooled it
- Management and optimisation in the preoperative phase for patients with a fractured hip.EFORT open reviews · 2026Review
- Perioperative Anemia and Transfusion Management in Older Adults with Osteoporotic Hip Fractures: A Narrative Review of Current Evidence and Emerging Strategies.Clinical interventions in aging · 2026Review
- Chronic anticoagulation therapy associated with increased complications following hemiarthroplasty in hip fracture patients.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Perioperative Management of Traditional and Direct Oral Anticoagulants in Hip Fracture Patients.Orthopedic reviews · 2024Article
- Impact of preoperative echocardiographic delay on timing of hip fracture surgery in elderly patients.SAGE open medicine · 2024Article
- Quality of Life and Post-Surgical Complications in Patients on Chronic Antiplatelet Therapy with Proximal Femur Fracture: 12-Month Follow-Up after Implementing a Strategy to Shorten the Time to Surgery.Journal of clinical medicine · 2023Article
- Early Surgical Care of Anticoagulated Hip Fracture Patients Is Feasible-A Retrospective Chart Review of Hip Fracture Patients Treated with Hip Arthroplasty within 24 Hours.Journal of clinical medicine · 2022Article
- Coagulopathy management of multiple injured patients - a comprehensive literature review of the European guideline 2019.EFORT open reviews · 2022Review
- The Perioperative Management of Antiplatelet and Anticoagulant Drugs in Hip Fractures: Do the Surgery as Early as Possible.The archives of bone and joint surgery · 2022Review
- Early Surgery with Neuraxial Anaesthesia in Patients on Chronic Antiplatelet Therapy with a Proximal Femur Fracture: Multicentric Randomised Clinical Trial.Journal of clinical medicine · 2021Article
- Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus.Aging clinical and experimental research · 2021Review
- Surgical Selection of Unstable Intertrochanteric Fractures: PFNA Combined with or without Cerclage Cable.BioMed research international · 2021Article
- Proximal femur fractures in patients taking anticoagulants.EFORT open reviews · 2020Review
- Evaluation of the use of anti-platelet therapy throughout the peri-operative period in patients with femoral neck fracture surgery. A retrospective cohort study.International orthopaedics · 2020Article
- Impact of Antiplatelet Therapies on Patients Outcome in Osteosynthetic Surgery of Proximal Femoral Fractures.Journal of clinical medicine · 2019Article
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- The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition.Critical care (London, England) · 2019Article
- Thromboembolism prophylaxis in orthopaedics: an update.EFORT open reviews · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFemoral neck fractures in the elderly make up a large proportion of Orthopaedic surgical admissions each year. Operating on patients with clopidogrel poses a challenge because of the risk of bleeding and the difficulty deciding the optimal timing of surgery. The aim of this systematic review is to examine the published evidence to establish a set of guidelines for approaching neck of femur patients who are on clopidogrel.
methodsAll comparative studies with an intervention group and a control group were considered. Data on patient blood transfusion exposures, units transfused, haemoglobin concentration and drop in haemoglobin were extracted and pooled using the fixed effects model. Heterogeneity of the intervention effect was assessed with the I (2) statistic.
resultsA total of 4219 studies were identified. After removal of duplicates and after exclusion criteria were applied, there were 14 studies to be included. All 14 were case series with controls. There was no significant heterogeneity amongst the studies. Pooled odds ratio for transfusion exposures was 1.24 (95 % confidence interval 0.91 to 1.71) however this was not statistically significant (p = 0.14). No significant mean differences were found for other primary outcome measures.
conclusionsOn the available evidence, we recommend that these patients can be managed by normal protocols with early surgery. Operating early on patients on clopidogrel is safe and does not appear to confer any clinically significant bleeding risk. As reported in other studies, we believe clopidogrel, if possible, should not be withheld throughout the perioperative period due to increased risk of cardiovascular events associated with stopping clopidogrel. Care should be taken intraoperatively to minimise blood loss due to the increased potential for bleeding.
trial registrationThis systematic review and meta-analysis has been registered on Research Registry on July 16, 2015. The Review Registry Unique Identifying Number is: reviewregistry61 .
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.