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Journal Reading: Effect of

Anticoagulants on Outcome of
Femoral Neck Fracture Surgery
Pembimbing: Letkol CKM dr. Basuki
Widodo, Sp.OT
Aini Fuada Sardjono (1420221176)

Abstract
Purpose. To review records of 330
patients who underwent surgery for
femoral neck fractures with or
without preoperative anticoagulation
therapy.

Abstract (contd)
Methods

Abstract (contd)
Results
Category

Warfarin

Aspirin

Clopidogr
el

Control

Age

80.8

83.7

84.2

80.0

The patients
underwent surgery
The overall mean time
from admission to
surgery (1.8 days)

81% of the patients underwent surgery within 48 hours of


admission
3.3

The mean length of


hospital stay

1.8

1.6

1.6

354 days

The overall hospital


mortality (3.9%)

6.7%

3.8%

3.6%

3.6%

Postoperative
complication rate

1 haematoma

2 repositioning of
a malfixation and
for debridement
of wound
infection

1
debridemen
t of wound
infection

Abstract (contd)
Conclusion. It is safe to continue
aspirin and clopidogrel prior to
surgical treatment for femoral neck
fracture. The risk of delaying surgery
outweighs the peri-operative
bleeding risk

INTRODUCTION

INTRODUCTION(Contd)

MATERIALS AND METHODS


Ethics

RESULTS
Group

No. of M e a n
male:
age
female ( y e a r s )

Warfarin (n=30)
8 :2 2
Non-warfarin (n=300) 8 7 : 2 1 3
Aspirin (n=105)
35:70
Clopidogrel (n=28)
9 :1 9
Control (n=167)
4 3 :1 2 4

80.8
81.7
83.7
84.2
80.0

M ean
le n g th o f
h o s p ita l
s ta y (d a y s )

M ean
tim e fr o m
a d m is s io n
to s u rg e ry
(d a y s )

N o . ( % ) o f p a t ie n t s
W ound
in fe c tio n

19.3
17.7
19.4
17.3
16.7

3.3
1.7
1.8
1.6
1.6

2 (6.7)
8 (2.7)
2 (1.9)
0 (0)
6 (3.6)

D eep
P u lm o n a r y R e t u r n t o
venous
e m b o lis m
th e a tre
th ro m b o s is
0 (0)
3 (1.0)
2 (1.9)
0 (0)
1 (0.6)

1
5
2
1
2

(3 .3 )
(1 .7 )
(1 .9 )
(3 .6 )
(1 .2 )

1 (3.3)
3 (1.0)
2 (1.9)
0 (0)
1 (0.6)

Hospital
mortality
2
11
4
1
6

(6 .7 )
(3 .7 )
(3 .8 )
(3 .6 )
(3 .6 )

DISCUSSION
This study suggested that aspirin or
clopidogrel had minimal impact on hospital
mortality and postoperative complication rate,
whereas the time from admission to surgery
was longer in patients on warfarin.
The use of clopidogrel is reported to increase
bleeding and complication rates. Compared
with those not on clopidogrel, patients on
clopidogrel had approximately 200 ml higher
blood loss and had an increased complication
rate.

DISCUSSION
Patients on clopidogrel had increased risks of
bleeding and postoperative complications when
undergoing surgery within 48 hours of admission,
compared with those undergoing surgery after 48
hours of admission.
Nonetheless, confounders such as surgical
approach, surgical technique, and operating time
were not adjusted for. The increased blood loss was
not only due to the use of clopidogrel.
When clopidrogel was stopped preoperatively, 20%
of high-risk patients experienced an acute coronary
syndrome between postoperative days 4 and 8.

Discussion
Delayed surgery is associated with one-year
mortality in patients on clopidogrel with femoral
neck fracture.
Early operative treatment according to the Scottish
Intercollegiate Guidance Network guidelines is
suggested.
The British Orthopaedic Association stresses the
importance of early surgery for patients with hip
fracture, and sets a maximum delay of 48 hours.
Compared with those not on warfarin, patients on
warfarin have higher risks of postoperative wound
infection after total hip/knee replacement

Discussion
In our study, the lack of significant
differences between the 4 groups in
terms of hospital mortality and
complications may have been due to
a type-II error; the number of
patients was relatively small in the
clopidogrel and warfarin groups. The
mean patient age also differed
significantly between groups,
although it is unlikely to have been a

CONCLUSION
It is safe to continue aspirin and
clopidogrel prior to surgical
treatment for femoral neck fracture.
The risk of delaying surgery
outweighs the peri-operative
bleeding risk

Critical Appraisal

Judul & Pengarang


No.

Kriteria

Ya (+) atau Tidak


(-)

Jumlah kata dalam judul <12 kata

Deskripsi Judul

Menggambarkan isi
utama penelitian,
menarik dan tanpa
singkatan

Daftar penulis sesuai aturan jurnal

Korespondensi penulis

Tempat dan Waktu penelitian dalam


judul

Abstrak
No.

Kriteria

Ya (+) atau Tidak


(-)

Abstrak satu paragraf

Mencakup komponen IMRC

Secara keseluruhan informatif

Tanpa singkatan selain yang baku

< 250 kata

- (339)

Pendahuluan
No.

Kriteria

Ya (+) atau Tidak


(-)

Terdiri dari 2 bagian/2 paragraf

Paragraf pertama mengemukakan


alasan dilakukan penelitian

Paragraf kedua menyatakan hipotesis


atau tujuan penelitian

Didukung oleh pustaka yang relefan

< satu halaman

Bahan & Metode


No.

Kriteria

Ya (+) atau Tidak


(-)

Jenis dan rancangan penelitian

Waktu dan tempat penelitian

Waktu +, tempat -

Populasi Sumber

Teknik sampling

Kriteria inklusi

Kriteria eksklusi

Perkiraan dan perhitungan jumlah


sampel

Perincian cara penelitian

Blind

10

Uji statistik

11

Program komputer

12

Penentuan Subjek

Hasil
No.

Kriteria

Ya (+) atau Tidak


(-)

Jumlah subjek

Tabel Karakteristik

Tabel Hasil Penelitian

Komentar dan pendapat penulis


tentang hasil

Tabel analsis data dengan uji

Pembahasan, Kesimpulan,
Daftar Pustaka
No.

Kriteria

Ya (+) atau Tidak


(-)

Pembahasan dan kesimpulan dibahas


terpisah

Pembahasan dan kesimpulan


dipaparkan dengan jelas

Pembahasan mengacu dari penelitian


sebelumnya

Pembahasan sesuai landasan teori

Keterbatasan penelitian

+ (jumlah sampel
yang sedikit, range
usia)

Simpulan berdasarkan penelitian

Saran Penelitian

Penulisan Pustaka sesuai aturan

Aplikasi
Pertanyaan

Jawaban

Apakah pada pasien kita terdapat


perbedaan bila dibandingkan dengan
yang terdapat pada penelitian
sebelumnya sehingga hasil tersebut
tidak dapat diterapkan pada pasien
kita

Tidak

Apakah pemberian terapi tersebut


dapat diterapkan pada pasien kita?

Tidak

Apakah pasien memiliki potensial yang


menguntungkan

Ya

Study Validity
Research Question

Study Validity
Follow-up

Results
Selection of outcomes

Thank You