Hip Fracture
Conditions
Keywords
Hip Fracture, Clopidogrel, Withdrawal, surgical timing, Thromboelastogram
Brief summary
In the elderly patients with hip fracture, some often take antiplatelet drugs such as clopidogrel due to the ischemic cardiovascular or cerebrovascular diseases. In traditional practice, these patients often need to stop medication for 5-7 days before surgery. But on the other hand, delayed surgery will lead to a significant increase in fracture related complications. Therefore, the appropriate time for drug withdrawal is particularly important in this population. Thromboelastography is a monitoring method that can accurately judge the anticoagulation status of patients. We hope to use thromboelastography to guide the time of drug withdrawal, shorten the time of drug withdrawal as much as possible, and reduce the incidence of fracture related complications without increasing the risk of massive hemorrhage.
Interventions
PROCEDUREThrombelastograph and surgical timing
Patients in the TEG group will undergo a Thrombelastograph test after admission, and the timing of operation will be determined according to the results of the test, that is, 1 day, 3 days and 5 days later respectively for patients with ADP-induced platelet-fibrin clot strength (MAADP) of \> 50 mm, 30-50 mm and \< 30 mm. For Non-TEG patients, the drug withdrawal time is determined by the doctor in charge according to the clinical routine, generally about one week.
Sponsors
Second Affiliated Hospital, School of Medicine, Zhejiang University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* hip fracture and operation * taking clopidogrel for more than one week before injury, with or without taking aspirin at the same time
Exclusion criteria
* high energy injury (such as traffic accident, falling from height), bilateral hip fracture, multiple fractures or injuries, pathological fracture * malignant tumor patients * hormone users * patients with recent active bleeding or bleeding ulcer * primary or secondary coagulation dysfunction or depression caused by other reasons than taking antiplatelet drugs (for example, taking warfarin) * patients with other acute or unstable diseases requiring delayed surgery (acute heart failure, myocardial infarction, cerebral infarction, cerebral hemorrhage, severe pulmonary infection, deep vein thrombosis or pulmonary embolism, etc.)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Estimated red blood cell loss | From admission when the first blood routine will be obtained to discharge when the last blood routine will be obtained, up to postoperative day 7. | The amount of red blood cell loss estimated by blood routine changes |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood transfusion | From admission when the first blood routine will be obtained to discharge when the last blood routine will be obtained, up to postoperative day 7. | Red blood cell infusion volume |
Other
| Measure | Time frame | Description |
|---|---|---|
| Length of stay | from admission to discharge,up to one year after operation | Total length of stay |
| Mortality | within one year after operation | One year all-cause mortality |
| Cerebrovascular accident | within one year after operation | Ischemic brain disease |
| Acute coronary syndrome | within one year after operation | Ischemic heart disease |
Contacts
Primary ContactMin Yan, Doctor
Outcome results
None listed