Post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture: a meta-analysis

Abstract

Background: The number of patients with hip and femoral fractures is increasing and is expected to further increase in upcoming years due to the ageing population and the life expectancy of the general population. In this analysis, we aimed to systematically assess the post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture.

Methods: Common online databases: Google Scholar, Web of Science, MEDLINE, Cochrane database, EMBASE ( www.sciencedirect.com ), and http://www.

Clinicaltrials: gov were searched for English-based studies which reported post-operative outcomes in patients with versus without the use of Aspirin prior to surgery for hip or femoral fracture. The endpoints of this analysis included cerebro-vascular attack, acute coronary syndrome/cardiovascular complications, hematoma, deep venous thrombosis, pulmonary embolism, patients requiring blood transfusion, bleeding events, and in-hospital mortality. RevMan software 5.4 was the statistical software used for this meta-analysis. Risk ratio (RR) with 95% confidence intervals (CI) was used to represent the post-analytical result.

Results: A total number of 2823 participants were included in this analysis whereby 821 were assigned to Aspirin prior to surgery. Results of this analysis showed that post-operatively the risk of cerebrovascular attack (RR: 1.62, 95% CI 0.29-9.20; P = 0.58), cardiovascular complication (RR: 1.86, 95% CI 0.62-5.52; P = 0.27), pulmonary embolism (RR: 2.45, 95% CI 0.77-7.77; P = 0.13), bleeding events (RR: 1.24, 95% CI 0.39-3.96; P = 0.71), and in-hospital mortality (RR: 0.95, 95% CI 0.47-1.91; P = 0.89) were not significantly higher in those patients who were and who were not taking Aspirin pre-operatively. The risk of deep venous thrombosis (RR: 1.82, 95% CI 0.23-14.60; P = 0.57), hematoma formation (RR: 1.57, 95% CI 0.11-21.49; P = 0.74) and patients requiring blood transfusion post-operatively (RR: 1.22, 95% CI 0.99-1.52; P = 0.07) were not significantly different in patients who were on Aspirin and those who were not on Aspirin pre-operatively.

Conclusion: The post-operative complications associated with the pre-operative use of Aspirin in patients undergoing surgery for hip or femoral fracture were apparently not significantly different when compared to patients who were not on Aspirin. Therefore, Aspirin should not be considered an absolute contraindication in patients undergoing surgery for hip or femoral fracture. Hence, an early or emergency surgery for hip or femoral neck fracture in patients on Aspirin therapy should apparently not pose any problem. Further larger trials should be able to confirm this hypothesis.

Keywords: Anti-platelets; Aspirin; Bleeding events; Deep venous thrombosis; Femoral fracture; Hip fracture; Post-operative complications; Pulmonary embolism.