Continuation of antiplatelet therapy in patients with hip fractures: A critical review and retrospective analysis

Hip fractures in the elderly represent a significant cause of morbidity and mortality. A considerable proportion of these patients are on antiplatelet medications, such as aspirin (Ecospirin) and clopidogrel (Clopitab), for secondary prevention of cardiovascular events. The perioperative management of these medications poses a clinical dilemma, balancing the risk of thromboembolic complications with the potential for increased bleeding during and after surgery. This detailed review critically examines the existing literature regarding the continuation of antiplatelet therapy in patients undergoing hip fracture surgery. Furthermore, we present a retrospective analysis of 104 patients with hip fractures, including 34 patients on antiplatelet therapy (25 on Ecospirin, 7 on Clopitab, and 2 on dual therapy), evaluating the incidence of perioperative bleeding complications and thromboembolic events. Our findings suggest that the continued use of single or dual antiplatelet therapy in this patient population does not significantly increase the risk of major bleeding requiring intervention and may potentially offer protection against thromboembolic events. Therefore, routine discontinuation of these medications may not be necessary and should be individualized based on a careful assessment of the patient's cardiovascular risk and bleeding risk.