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Assessing the risk of clopidogrel-related bleeding complications in patients undergoing inguinal herniorrhaphy
E W Chu1, D A Telem, A Chernoguz
1Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1259, New York, NY 10029-6574, USA. edward.chu@mssm.edu
Insights
Clopidogrel use within 7 days of inguinal herniorrhaphy did not increase bleeding risks. Increased hospital admissions in this group were due to non-bleeding factors, suggesting therapy interruption may not be necessary.
Area of Science:
- Cardiology
- Gastroenterology
- Surgical Oncology
Background:
- Preoperative management of clopidogrel, an irreversible antiplatelet agent, is not well-studied for minor procedures.
- Investigating clopidogrel's impact on bleeding complications after inguinal herniorrhaphy is crucial.
Purpose of the Study:
- To determine if clopidogrel use within 7 days of inguinal herniorrhaphy increases postoperative bleeding risks.
- To assess the association between clopidogrel timing and bleeding-related morbidity or mortality.
Main Methods:
- Retrospective chart review of 46 patients undergoing inguinal herniorrhaphy while on clopidogrel.
- Patients grouped by last clopidogrel dose: <7 days (Group A) and ≥7 days (Group B).
Main Results:
- No significant differences in blood loss, transfusion needs, or bleeding complications between groups.
- Group A showed higher postoperative admission rates (65% vs. 15%) and longer hospital stays, primarily due to non-bleeding factors.
- One patient in Group A developed a hematoma, consistent with general population rates; no difference in bleeding-related admissions was observed.
Conclusions:
- Clopidogrel use within 7 days of inguinal herniorrhaphy does not elevate perioperative bleeding risks.
- Increased admissions and hospital stay in Group A were linked to non-bleeding patient factors.
- Interrupting clopidogrel therapy before inguinal herniorrhaphy may not be necessary for high-risk patients.
Background:
To date, no studies have investigated how the preoperative management of clopidogrel, an irreversible antiplatelet agent, influences the outcome following minor operative procedures. The purpose of this study is to determine if clopidogrel use within 7 days of inguinal herniorrhaphy increases the postoperative risk for bleeding-related morbidity or mortality.
Methods:
A retrospective chart review was performed of 46 patients on clopidogrel who underwent inguinal herniorrhaphy from 2004 to 2008. Patients were grouped based on the last administered dose of clopidogrel; <7 days (A) and ≥ 7 days (B).
Results:
Of the 46 patients, 20 were in group A and 26 were in group B. No significant differences in operative blood loss, perioperative transfusion requirement, postoperative bleeding complications, intensive care unit (ICU) requirements, mortality, or 30-day readmission/reoperation rates were demonstrated between patients in groups A and B. Patients in group A had a significantly increased postoperative admission rate (65% vs. 15%, P = 0.0002) and increased mean hospital stay (1.0 vs. 0.15 days, P = 0.003). However, urinary retention, pain management, and the monitoring of other conditions accounted for over 80% of these admissions. One patient in group A (5%) developed a postoperative hematoma, which is consistent with the complication rate seen in the general population after inguinal herniorrhaphy. Overall, no difference in admission secondary to hematoma or postoperative bleeding was demonstrated.
Conclusion:
Clopidogrel use within 7 days of inguinal herniorrhaphy did not increase the risk for perioperative bleeding complications. No mortalities, readmissions, or ICU requirements occurred, regardless of the timing of clopidogrel cessation. The increased risk for hospital admission and length of stay seen in group A is likely to be attributable to nonbleeding-related patient factors rather than clopidogrel use. Thus, it may not be necessary to interrupt clopidogrel therapy prior to inguinal herniorrhaphy in high-risk patients.
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