{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:23:24Z","timestamp":1791210204817,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI16\/01879"],"award-info":[{"award-number":["PI16\/01879"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Patients with proximal femur fracture on antiplatelet treatment benefit from early surgery. Our goal was to perform early surgery under neuraxial anaesthesia when indicated by the platelet function test. Methods: We conducted a multicentre randomised open-label parallel clinical trial. Patients were randomised to either early platelet function-guided surgery (experimental group) or delayed surgery (control group). Early surgery was programmed when the functional platelet count (as measured by Plateletworks) was &gt;80 \u00d7 109\/L. The primary outcome was the emergency admission-to-surgery interval. Secondary outcomes were platelet function, postoperative bleeding, medical and surgical complications, and mortality. Results: A total of 156 patients were randomised, with 78 in each group, with a mean (SD) age of 85.96 (7.9) years, and 67.8% being female. The median (IQR) time to surgery was 2.3 (1.5\u20133.7) days for the experimental group and 4.9 (4.4\u20135.6) days for the control group. One-third of patients did not achieve the threshold functional platelet count on the first day of admission, requiring more than one test. There was no difference in clinical outcomes between groups. Conclusions: A strategy individualised according to the platelet function test shortens the time to proximal femur fracture surgery under neuraxial anaesthesia in patients on chronic antiplatelet treatment. Better powered randomised clinical trials are needed to further evaluate the clinical impact and safety of this strategy.<\/jats:p>","DOI":"10.3390\/jcm10225371","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T08:53:56Z","timestamp":1637225636000},"page":"5371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Early Surgery with Neuraxial Anaesthesia in Patients on Chronic Antiplatelet Therapy with a Proximal Femur Fracture: Multicentric Randomised Clinical Trial"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2746-5388","authenticated-orcid":false,"given":"Rafael","family":"Anaya","sequence":"first","affiliation":[{"name":"Anesthesiology Service, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireia","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Anesthesiology Service, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ang\u00e9lica","family":"Millan","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Surgery Service, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Reguant","sequence":"additional","affiliation":[{"name":"Anesthesiology Service, Xarxa Assitencial Universit\u00e0ria de Manresa, 08243 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Llorca","sequence":"additional","affiliation":[{"name":"Anesthesiology Service, Xarxa Assitencial Universit\u00e0ria de Manresa, 08243 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Guilabert","sequence":"additional","affiliation":[{"name":"Anesthesiology Service, Hospital de la Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Anesthesiology Service, Hospital Clinic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4095-8988","authenticated-orcid":false,"given":"Percy-Efrain","family":"Pantoja","sequence":"additional","affiliation":[{"name":"Public Health and Clinical Epidemiology Service-Iberoamerican Cochrane Centre, IIB Sant Pau, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1422-0883","authenticated-orcid":false,"given":"Jos\u00e9 Mar\u00eda","family":"Gil","sequence":"additional","affiliation":[{"name":"Anesthesiology Service, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Moral","sequence":"additional","affiliation":[{"name":"Anesthesiology Service, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Merch\u00e1n-Galvis","sequence":"additional","affiliation":[{"name":"Public Health and Clinical Epidemiology Service-Iberoamerican Cochrane Centre, IIB Sant Pau, 08025 Barcelona, Spain"},{"name":"Departamento de Medicina Social y Salud Familiar, Universidad del Cauca, Popayan 190003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5836-1138","authenticated-orcid":false,"given":"Maria Jose","family":"Martinez-Zapata","sequence":"additional","affiliation":[{"name":"Public Health and Clinical Epidemiology Service-Iberoamerican Cochrane Centre, IIB Sant Pau, 08025 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the AFFEcT Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1302\/0301-620X.93B6.25596","article-title":"The outcome of fractures in very elderly patients","volume":"93","author":"Clement","year":"2011","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1001\/jama.2009.1462","article-title":"Incidence and mortality of hip fractures in the United States","volume":"302","author":"Brauer","year":"2009","journal-title":"JAMA"},{"key":"ref_3","first-page":"483","article-title":"Early mortality after hip fracture: Is delay before surgery important?","volume":"87","author":"Moran","year":"2005","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s10654-005-4280-9","article-title":"Risk factors correlated with postoperative mortality for hip fracture surgery in the elderly: A population-based approach","volume":"20","author":"Franzo","year":"2005","journal-title":"Eur. J. Epidemiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1093\/aje\/kwp266","article-title":"The aftermath of hip fracture: Discharge placement, functional status change, and mortality","volume":"170","author":"Bentler","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_6","unstructured":"Institute of Health Information (2018, July 02). Annotated Statistics: Attention to Hip Fracture in SNS Hospitals, Available online: https:\/\/www.msssi.gob.es\/estadEstudios\/estadisticas\/docs\/Estadisticas_comentadas_01.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s00198-011-1651-9","article-title":"The direct cost of acute hip fracture care in care home residents in the UK","volume":"23","author":"Sahota","year":"2012","journal-title":"Osteoporos. Int."},{"key":"ref_8","unstructured":"AAOS (2018, July 02). Management of Hip Fractures in the Elderly Evidence-Based Clinical Practice Guideline. Adopted by the American Academy of Orthopaedic Surgeons Board of Directors. Available online: https:\/\/www.aaos.org\/research\/guidelines\/hipfxguideline.pdf."},{"key":"ref_9","unstructured":"National Institute for Health and Clinical Excellence (2017). Hip Fracture: Management, National Institute for Health and Care Excellence. Clinical guideline [CG124]."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s13018-020-01624-7","article-title":"Is hip fracture surgery safe for patients on antiplatelet drugs and is it necessary to delay surgery? A systematic review and meta-analysis","volume":"15","author":"Yang","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Soo, C.G., Della Torre, P.K., Yolland, T.J., and Shatwell, M.A. (2016). Clopidogrel and hip fractures, is it safe? A systematic review and meta-analysis. BMC Musculoskelet. Disord., 17.","DOI":"10.1186\/s12891-016-0988-9"},{"key":"ref_12","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? Systematic review, meta-analysis, and meta-regression","volume":"46","author":"Doleman","year":"2015","journal-title":"Injury"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/ALN.0000000000001899","article-title":"Association of hospital- level neuraxial anesthesia use for hip fracture surgery with outcomes: A population-based cohort study","volume":"128","author":"McIsaac","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Van Waesberghe, J., Stevanovic, A., Rossaint, R., and Coburn, M. (2017). General vs. neuraxial anesthesia in hip fracture patients: A systematic review and meta-analysis. BMC Anesthesiol., 17.","DOI":"10.1186\/s12871-017-0380-9"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e013473","DOI":"10.1136\/bmjopen-2016-013473","article-title":"Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN): Protocol for a pragmatic, international multicenter trial","volume":"6","author":"Neuman","year":"2016","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e023609","DOI":"10.1136\/bmjopen-2018-023609","article-title":"Improve hip fracture outcome in the elderly patient (iHOPE): A study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anesthesia","volume":"8","author":"Kowark","year":"2018","journal-title":"BMJ Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e016937","DOI":"10.1136\/bmjopen-2017-016937","article-title":"Comparison of regional with general anaesthesia on postoperative delirium (RAGA-delirium) in the older patients undergoing hip fracture surgery: Study protocol for a multicentre randomised controlled trial","volume":"7","author":"Li","year":"2017","journal-title":"BMJ Open"},{"key":"ref_18","first-page":"310","article-title":"Epidural Hematoma Following Interlaminar Epidural Injection in Patient Taking Aspirin","volume":"43","author":"Sanders","year":"2018","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1213\/ANE.0000000000001312","article-title":"Neuraxial Anesthesia in Parturients with Low Platelet Counts","volume":"123","author":"Bernstein","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1111\/bjh.14344","article-title":"British Committee of Standards for Haematology. Perioperative management of anticoagulation and antiplatelet therapy","volume":"175","author":"Keeling","year":"2016","journal-title":"Br. J. Haematol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.recesp.2018.01.001","article-title":"Perioperative and Periprocedural Management of Antithrombotic Therapy: Consensus Document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU","volume":"71","author":"Vivas","year":"2018","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.redar.2018.07.003","article-title":"Recommendations for perioperative antiplatelet treatment in non-cardiac surgery. Working Group of the Spanish Society of Anaesthesiology-Resuscitation and Pain Therapy, Division of Haemostasis, Transfusion Medicine, and Perioperative Fluid Therapy Update of the Clinical practice guide 2018","volume":"66","author":"Sierra","year":"2019","journal-title":"Rev. Esp. Anestesiol. Reanim."},{"key":"ref_23","first-page":"225","article-title":"Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain","volume":"43","author":"Narouze","year":"2018","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.athoracsur.2012.07.086","article-title":"2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations","volume":"94","author":"Ferraris","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1161\/CIRCINTERVENTIONS.111.967208","article-title":"Platelet function measurement- based strategy to reduce bleeding and waiting time in clopidogrel-treated patients undergoing coronary artery bypass graft surgery: The timing based on platelet function strategy to reduce clopidogrel-associated bleeding related to CABG (TARGET-CABG) study","volume":"5","author":"Mahla","year":"2012","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e15514","DOI":"10.1097\/MD.0000000000015514","article-title":"Evaluation of a strategy to shorten the time to surgery in patients on antiplatelet therapy with a proximal femur fracture (AFFEcT Study)","volume":"98","author":"Rafael","year":"2019","journal-title":"Medicine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1365-2141.2009.07899.x","article-title":"The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals","volume":"148","author":"Nokes","year":"2010","journal-title":"Br. J. Haematol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/BF03256290","article-title":"Plateletworks: A novel point of care platelet function screen","volume":"12","author":"Campbell","year":"2008","journal-title":"Mol. Diagn. Ther."},{"key":"ref_29","first-page":"224","article-title":"Prediction of blood volume in normal human adults","volume":"51","author":"Nadler","year":"1962","journal-title":"Surgery"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/22\/5371\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:32:15Z","timestamp":1760167935000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/22\/5371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,18]]},"references-count":29,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10225371"],"URL":"https:\/\/doi.org\/10.3390\/jcm10225371","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,18]]}}}