1. 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
- Author
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Merchán-Galvis, Angela, Anaya, Rafael, Rodriguez, Mireia, Llorca, Jordi, Castejón, Mercé, Gil, José María, Millan, Angélica, Estepa, Verónica, Cardona, Elena, Garcia-Sanchez, Yaiza, Ruiz, Ana, Martinez-Zapata, Maria Jose, Group, AFFEcT Study Group AFFEcT Study, Institut Català de la Salut, [Merchán-Galvis A] Public Health and Clinical Epidemiology Service—Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain. Department of Social Medicine and Family Health, Universidad del Cauca, Popayan, Colombia. [Anaya R, Rodriguez M, Gil JM] Anesthesiology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. [Llorca J, Castejón M] Anesthesiology Service, Xarxa Assitencial Universitària de Manresa, Barcelona, Spain. [Estepa V, Cardona E] Servei d’Anestesiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Garcia-Sanchez Y] Servei de Cirurgia Ortopèdica i Traumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Cirurgia - Complicacions ,Fèmur - Ferides i lesions - Tractament ,acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos hematológicos::inhibidores de la agregación plaquetaria [COMPUESTOS QUÍMICOS Y DROGAS] ,antiplatelet drugs ,General Medicine ,Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications [DISEASES] ,randomized clinical trial ,afecciones patológicas, signos y síntomas::procesos patológicos::complicaciones posoperatorias [ENFERMEDADES] ,Environment and Public Health::Public Health::Epidemiologic Measurements::Demography::Health Status::Quality of Life [HEALTH CARE] ,Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Platelet Aggregation Inhibitors [CHEMICALS AND DRUGS] ,heridas y lesiones::fracturas óseas::fracturas del fémur [ENFERMEDADES] ,Plaquetes sanguínies - Agregació ,femur fracture ,Wounds and Injuries::Fractures, Bone::Femoral Fractures [DISEASES] ,Qualitat de vida - Avaluació ,ambiente y salud pública::salud pública::medidas epidemiológicas::demografía::estado de salud::calidad de vida [ATENCIÓN DE SALUD] - Abstract
Antiplatelet drugs; Femur fracture; Randomized clinical trial Fármacos antiplaquetarios; Fractura de fémur; Ensayo clínico aleatorizado Medicaments antiplaquetaris; Fractura de fèmur; Assaig clínic aleatoritzat Background: We evaluated a strategy to shorten the time from admission to surgery in patients with proximal femur fractures on chronic antiplatelet therapy. We reported a 12-month follow-up on complications and quality of life (QoL). Methods: Multicentre, open-label, randomized, parallel clinical trial. Patients were randomized to either early platelet function-guided surgery (experimental group) or delayed surgery (control group). Medical and surgical complications and QoL (EQ-5D-5L questionnaire) were assessed during the hospital stay, and after hospital discharge at 30 days, and 6 and 12 months. Results: From 156 randomized patients, 143 patients underwent surgery. The mean age was 85.5 (7.8) years and 68.0% were female. After hospital discharge, 5.7% of patients had surgical wound complications and 55.9% had medical complications, with 42.7% having serious adverse events. QoL improved significantly after surgery, with the best scores at the six-month follow-up. The overall mortality was 32.2%. There were no differences between early and delayed surgery groups in any assessed outcomes. Conclusion: It seems safe to reduce the time of surgery under neuraxial anaesthesia in patients with hip fractures on chronic antiplatelet therapy by platelet function testing. QoL in particular improves in the first six months after surgery. This research was funded by Instituto de Salud Carlos III and European Regional Development Fund (ERDF), “A way to make Europe”, grant number PI16/01879 and Spanish Clinical Research Network (PT17/0017/0034 and PT20/00096). Biometa Tecnologias y Sistemas (33428 Llanera, Asturias, Spain) partially funded the PLATELETWORKS reagent kits. The sponsor and funders are not involved in study design; collection, management, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication.
- Published
- 2023