{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T18:45:08Z","timestamp":1764701108223,"version":"3.44.0"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:00:00Z","timestamp":1708473600000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The perioperative management of patients on antiplatelet drugs is a rising challenge in orthopedic trauma because antiplatelet drugs are frequently encountered and carry an increased risk of hemorrhagic consequences. The study objective was to examine the effect of aspirin on bleeding outcomes for patients with lower extremity fractures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective study included patients requiring surgical fixation of traumatic hip, femur, and tibia fractures from January 1, 2018, to March 1, 2020. Patients were excluded if they had a significant head injury, were on chronic anticoagulant therapy, or they did not receive venous thromboembolism chemoprophylaxis. Comparisons between aspirin users (patients on aspirin therapy preinjury) and non-aspirin users were examined using \u03c7<jats:sup>2<\/jats:sup> tests, Cochran-Mantel-Haenszel tests, and multivariate logistic regression. The primary outcome was an overt, actionable bleed (eg, blood transfusion for surgical site hemorrhage) within 24 hours postoperative.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 864 patients with lower extremity long bone fractures and 24% were aspirin users. The incidence of postoperative bleeding was 8.8% and significantly differed for patients taking aspirin versus not (13.6% vs 7.3%, p=0.01). However, biological sex at birth (M\/F) was a significant effect modifier (interaction p=0.04). Among women, there were significantly more postoperative bleeds for aspirin users (17.8% aspirin vs 7.4%\u2009no aspirin, adjusted OR (AOR): 2.48 (1.28\u20134.81), p=0.01). Among men, there were similar postoperative bleeding events by aspirin use (5.6% aspirin vs 7.2%\u2009no aspirin, AOR: 0.50 (0.14\u20131.82), p=0.30). Postoperative hemoglobin values &lt;8\u2009g\/dL were more frequent among female aspirin users (21.5% aspirin vs 12.5%\u2009no aspirin, p=0.01), but this association was not observed in men (p=0.43).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Women taking aspirin who suffer lower extremity fractures have greater than twofold greater odds of a postoperative bleeding event. These findings suggest adequate perioperative planning to ensure blood availability, and increased awareness to monitor closely for hemorrhage in the 24-hour postoperative window for women taking aspirin preinjury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>IV<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2023-001282","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:28:13Z","timestamp":1708561693000},"page":"e001282","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Association of sex and aspirin use with postoperative bleeding in patients with lower extremity long bone fractures"],"prefix":"10.1136","volume":"9","author":[{"given":"Michael","family":"Fisher","sequence":"first","affiliation":[{"name":"Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Salottolo","sequence":"additional","affiliation":[{"name":"Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Carrick","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Medical City Plano, Plano, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chad M","family":"Corrigan","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Wesley Medical Center, Wichita, Kansas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaysie L","family":"Banton","sequence":"additional","affiliation":[{"name":"Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Madayag","sequence":"additional","affiliation":[{"name":"Trauma Services Department, St Anthony Hospital, Lakewood, Colorado, USA"},{"name":"Trauma services Department, Lutheran Medical Center, Wheat Ridge, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3685-314X","authenticated-orcid":false,"given":"David","family":"Bar-Or","sequence":"additional","affiliation":[{"name":"Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"2025082410465971000_9.1.e001282.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0244291","article-title":"Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish fracture register in a well-defined catchment area","volume":"15","author":"Bergh","year":"2020","journal-title":"PLoS One"},{"key":"2025082410465971000_9.1.e001282.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-021-04291-9","article-title":"Changing epidemiology of lower extremity fractures in adults over a 15-year period - a national hospital discharge Registry study","volume":"22","author":"Hemmann","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"2025082410465971000_9.1.e001282.3","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1530\/EOR-22-0028","article-title":"Proximal Femur fractures in patients taking anti-Coagulants: has anything changed","volume":"7","author":"Giannoudi","year":"2022","journal-title":"EFORT Open Rev"},{"key":"2025082410465971000_9.1.e001282.4","doi-asserted-by":"crossref","first-page":"596","DOI":"10.7326\/M19-0953","article-title":"Prevalence of aspirin use for primary prevention of cardiovascular disease in the United States: results from the 2017 national health interview survey","volume":"171","author":"O\u2019Brien","year":"2019","journal-title":"Ann Intern Med"},{"key":"2025082410465971000_9.1.e001282.5","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2112"},{"key":"2025082410465971000_9.1.e001282.6","doi-asserted-by":"crossref","first-page":"e207","DOI":"10.1016\/j.chest.2022.07.025","article-title":"Perioperative management of Antithrombotic therapy: an American college of chest physicians clinical practice guideline","volume":"162","author":"Douketis","year":"2022","journal-title":"Chest"},{"key":"2025082410465971000_9.1.e001282.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2011.01.011"},{"key":"2025082410465971000_9.1.e001282.8","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/j.injury.2015.03.024","article-title":"Is early hip fracture surgery safe for patients on Clopidogrel? 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