Clopidogrel And Hip Fractures : A Systematic Review

The author considers the simplest way of finding out best practice is by using guidelines. According to Field & Lohr (1992) guidelines are “systematic developed statements to assist practitioners and patients decisions for specific clinical circumstances.” Evidence is always current and a generous collection of many different systematic research reviews with multiple random control trials are available (AGREE, 2000). These types of trials are graded at the top level of hierarchy (Guyatt et al 2002).Nevertheless in contrast Devereaux and Yusuf (2005) argue that top level hierarchy is not a guaranteed deviation from the truth in randomized trials. The clinical guidance used is the National Institute of Clinical Guidance (NICE 2009) is based in the author’s homeland and is an independent organisation responsible for providing guidelines. The ethos behind NICE (2009) is to promote and prevent poor health nationally involving the public, health professionals and patients in the process (NICE 2009).

Surgery itself has a risk of bleeding however; continuing anticoagulation up until surgery will predispose the patient of increased risk of bleeding and the potential need for more blood products. Warfarin should be stopped about five days before surgery to have its antithrombotic effects wear off (Jaffer, Brotman, & Chukwumerije, 2003). Surgery is usually safely performed when INR is lower than 1.5 (Jaffer et al. 2003). The surgery should be rescheduled when INR levels are normalized. However, if surgery is emergent the physician can reverse warfarin effects on INR by giving the patient vitamin K and fresh frozen plasma (Jaffer et al.,

The main co-morbidities with the cohort were: hypertension (65, 85.5%), diabetes type 2 (36, 47.4%) , and HF (28, 36.8%). Stroke was evident in 18 cases (23.7%), transient ischemic attack-TIA (10, 13.2%), and myocardial infarction (MI) (8, 10.5%). The least reported morbidities were thrombo-embolism-TE (5, 56.6%), and pulmonary embolism-PE (2, 2.6%). There were (9, 11.8%) patients taking Clopidogrel concomitantly

The topic in this systematic review is clearly defined, initially in the abstract, and being repeated in the introduction. Yes, the search for studies and other evidence was comprehensive and unbiased as it was able to be. Strict criteria were followed as described in Figure 1. Yes, the screening of citations for inclusion in this review was based on explicit criteria, as they wanted to promote confidence in the outcomes appropriate guidelines were followed carefully. Yes, the included studies were evaluated for

However, both studies only use Randomized Controlled Trial study, Clinically Controlled Trial and Trial Study were selected. According to Abalos E, Carroli G, Mackey ME, Bergel E (2001), Randomized controlled trials provide the most reliable results with regard to the effectiveness of interventions. This review is clearly defined about the sample condition, the intervention, a comparison and control, and the outcome measure that is to be used to determine the effectiveness. It is important as the effects of the intervention may be different in different groups.

This specific article was chosen because it was a systematic review in the Cochrane Database of Systematic Reviews. This source is the best available evidence, and the fact that it is within the last 5 years and pertained to the specific question asked was also valuable in its selection.

Randomized double blind study involving 18,144 patients at 1147 site in 39 countries were followed between October 26, 2005 and July 8, 2010.

The primary objective of this study was to determine if the application of NMES is feasible in this patient group. In addition, whether it improves hip abductor and adductor peak torque in pelvic fracture rehabilitation compared to a placebo group.

So, it is crucial for the nurse to measure the aPTT of patients receiving IV heparin infusion every six hours and change the dose accordingly to achieve therapeutic levels and prevent the risk of bleeding (Alquwaizani, Buckley, Adams, & Fanikos 2013). According to Alquwaizani, Buckley, Adams, & Fanikos (2013), “hemorrhage is the main concerning adverse event with all anticoagulants” (p. 83). Hence, nurses should carefully assess all patients receiving an anticoagulant therapy whether orally, IV infusion, or subcutaneous injections for signs of bleeding such as bruises, hematoma, tarry or bloody stool, and bright red blood emesis. In addition, they must strictly adhere to IV heparin administration protocol per their organization policy. Statistically, no significant cases of bleeding disorders associated with the IV administration have been reported. This is because two nurses are required to verify the dose and weight of the patient prior to and during the infusion to assure safe IV administration process. According to Alquwaizani, Buckley, Adams, & Fanikos (2013), “0-7 % of major bleeding, fatal bleeding about 0–3 %, and heparin-induced thrombocytopenia (HIT, 1–5 %) are associated the major complications of Unfractionated Heparin (UFH) therapy” (p.

The author’s readily acknowledge the limitations of the study, but do not seem to factor these limitations into their interpretations. In spite of the numerous limitations and failures of process, as well as the repetitive lack of statistical significance, they still conclude that the results are clinically significant, but do not provide a foundation for this conclusion.

Venous thromboembolism (VTE) has become a major health concern with 300,000-600,000 of cases in the United States annually and contributes to a significant number of avoidable inpatient costs (C. Dooley, 2013). Venous thromboembolism is also cited as the leading cause of preventable in-patient deaths (Dooley, 2013). Research has indicated that post-operative patients on medical surgical units have a 13-31% risk of deep vein thrombosis without interventions using prophylactic antithrombotic therapy (Alhazzani et al., 2013). Deep vein thrombosis (DVT) is a common, yet preventable postoperative

The hip joint is one of the most important joints in the body and helps support half of our body weight while acting as a stable joint that allows three degrees of freedom. It also serves as a ball and socket joint, formed from the femoral head of the femur and the acetabulum on the pelvis. The hip joint functions to support and distribute loads on the hip between the upper and lower extremities. The hip’s linkage of upper and lower extremities functions to maintaining balance, standing body posture and coordination. The majority of the femoral head is composed of spongy bone which plays a major role in assisting the distribution and absorption of loads. The progressive death of bone cells due to ischemia results in structural damage and

The SG study was a multicenter double-blind study with block randomization of 410 participants that examined

Knols et al. (2005) included thirty-four randomized clinical trials and controlled clinical trials in their systematic review.

Through the search described above, 398 articles were identified as potential studies. Once duplicates were removed, 79 articles remained to be reviewed, of which 48 were excluded based on title and abstract. An additional 20 were excluded due to the fact that the studies did not adhere to the inclusion/exclusion criteria of our systematic review, mainly for reasons such as: excluding the diagnosis of CRPS, not including the necessary interventions, or being qualified as low-level evidence. Of note, three additional studies were screened in this process after having been identified as relevant via one of the included systematic reviews. At conclusion of the screening process, 11 studies were