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Safety of carotid endarterectomy while on clopidogrel (Plavix). Clinical article
Scott D Wait1, Adib A Abla, Brendan D Killory
1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Insights
Patients taking clopidogrel before carotid endarterectomy (CEA) did not experience increased permanent complications. While short-term use (within 5 days) showed minor bleeding increases, overall safety supports its continued use.
Area of Science:
- Vascular Surgery
- Cardiology
- Pharmacology
Background:
- Many patients require carotid endarterectomy (CEA) while on clopidogrel, a potent antiplatelet medication.
- The safety of continuing clopidogrel perioperatively for CEA is a significant clinical concern.
Purpose of the Study:
- To evaluate the association between preoperative clopidogrel use and perioperative complications in patients undergoing CEA.
- To determine if continuing clopidogrel increases bleeding or other adverse events.
Main Methods:
- Retrospective review of 182 patients undergoing CEA.
- Analysis of clopidogrel use within 8 days and 5 days prior to surgery.
- Comparison of complication rates between clopidogrel users and non-users.
Main Results:
- No statistically significant increase in morbidity or mortality was observed for clopidogrel use within 8 days of CEA.
- A small, significant increase in operative blood loss and manageable neck swelling occurred with clopidogrel use within 5 days.
- No permanent morbidity or mortality was elevated in either clopidogrel group.
Conclusions:
- Preoperative clopidogrel use appears safe for patients undergoing carotid endarterectomy.
- The findings support current clinical practice regarding perioperative antiplatelet management for CEA.
Object:
Many patients undergoing carotid endarterectomy (CEA) regularly take clopidogrel, a permanent platelet inhibitor. The authors sought to determine whether taking clopidogrel in the period before CEA leads to more bleeding or other complications.
Methods:
The authors performed a retrospective, institutional review board–approved review of 182 consecutive patients who underwent CEA. Clinical, radiographic, and surgical data were gleaned from hospital and clinic records. Analysis was based on the presence or absence of clopidogrel in patients undergoing CEA and was performed twice by considering clopidogrel use within 8 days and within 5 days of surgery to define the groups.
Results:
Taking clopidogrel within 8 days before surgery resulted in no statistical increase in any measure of morbidity or death. Taking clopidogrel within 5 days was associated with a small but significant increase in operative blood loss and conservatively managed postoperative neck swelling. No measure of permanent morbidity or death was increased in either clopidogrel group.
Conclusions:
Findings in this study support the safety of preoperative clopidogrel in patients undergoing CEA.
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