Preexisting antiplatelet therapy with thienopyridines (clopidogrel, prasugrel, ticagrelor, ticlopidine)

In patients with a hip fracture who are taking thienopyridines for secondary prevention following a cardiovascular or cerebrovascular event without a coronary stent, thienopyridines should be discontinued at admission because of the higher intraoperative and postoperative bleeding risk.

Neuraxial blockade is not possible for 7 to 14 days depending on the specific agent.

There is no specific antidote. In case of intraoperative bleeding, administer platelet transfusion.

Start low-dose thromboprophylaxis 24–48 hours postoperatively depending on the individual postoperative bleeding risk.

Resume thienopyridines on postoperative day 3–5, as soon as no early revision surgery is expected.