• Marco Tescione, Eugenio Vadalà, Graziella Marano, Enzo Battaglia, Andrea Bruni, Eugenio Garofalo, Federico Longhini, Serena Rovida, Nicola Polimeni, Rosalba Squillaci, Stefano Lascala, Gaetana Franco, Demetrio Labate, Massimo Caracciolo, and Sebastiano Macheda.
• Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. marcotescione.mt@gmail.com.
• J Clin Monit Comput. 2022 Jun 1; 36 (3): 823-828.

AbstractSurgery for hip fractures should be performed within 48 h from patient's admission. However, several factors including chronic antiplatelet therapy could delay operation. Among the totality of patients taking clopidogrel, up to 30% are resistant to the drug and have a normal platelets reactivity. We propose thromboelastography (TEG) with an ADP Platelet Mapping assay kit to assess platelet aggregation, a safe tool that could help to avoid surgery delay in those patients treated with antiplatelet therapy. A patient's blood sample was collected for aggregometry. If MA-ADP and platelets aggregation (%) were within normal values, the patient was fit for immediate surgery with neuraxial anesthesia and ultrasound-guided nerve block. If one of the two parameters or both were deranged, a mortality risk assessment was estimated. In the low risk category, the patients waited till normalization of the parameters, whereas in the high-risk group a general anesthesia and peripheral antalgic block was carried out. Nine patients were enrolled. Four of them showed normal aggregometry and surgery was performed within 24 h from admission. Two patients were classified as high mortality risk and surgery was carried out under general anesthesia. Three patients awaited operation till normalization of parameters. No peri or post-operative complications were reported. An aggregometry-guided protocol can safely expedite hip fracture surgery in patients taking clopidogrel. Nonetheless, in presence of a normal platelets function, clinician can opt for a neuraxial instead of general anesthesia reducing the incidence of postoperative delirium and cognitive dysfunction.Trial registration: prospectively registered at clinicaltrials.gov (NCT04642209; date of registration: 23rd November 2020).© 2021. The Author(s), under exclusive licence to Springer Nature B.V.

17 keywords...

hide…