Clopidogrel dilemma for orthopaedic surgeons

Area of Science:

• Orthopaedic Surgery
• Cardiology
• Pharmacology

Background:

• Patients on clopidogrel pose a management challenge for orthopedic surgeons.
• Balancing bleeding risks against the risks of discontinuing clopidogrel is crucial.

Purpose of the Study:

• To review current evidence on managing clopidogrel in orthopedic surgery.
• To guide orthopedic surgeons in perioperative clopidogrel management.

Main Methods:

• Literature review of existing evidence on perioperative clopidogrel use.
• Assessment of risks associated with continuing or discontinuing clopidogrel.
• Consideration of venous thromboprophylaxis.

Main Results:

• Limited high-quality evidence exists for perioperative clopidogrel in orthopedic surgery.
• Assessed risks include bleeding, stent thrombosis, and venous thromboembolism.
• Current practices and blood loss in orthopedic operations were evaluated.

Conclusions:

• Continuing clopidogrel perioperatively is preferred, especially for patients with drug-eluting stents, to prevent stent thrombosis.
• Careful bleeding risk assessment and management are essential.
• A team approach is recommended to individualize patient care and manage perioperative clopidogrel therapy.