Related Experiment Videos
Perioperative clopidogrel and postoperative events after hip and knee arthroplasties
Sumon Nandi1, Mehran Aghazadeh, Carl Talmo
1Department of Orthopedics, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA.
Insights
Holding clopidogrel (a platelet inhibitor) for at least 5 days before hip or knee arthroplasty may reduce bleeding complications. Resuming the medication immediately after surgery did not increase adverse events.
Area of Science:
- Orthopedic Surgery
- Cardiology
- Pharmacology
Background:
- Vascular disease is common in patients undergoing hip and knee arthroplasty.
- Clopidogrel, a platelet inhibitor, reduces thrombosis but increases bleeding risk.
- Optimal perioperative clopidogrel management remains unclear.
Purpose of the Study:
- To examine the association between perioperative clopidogrel timing and postoperative bleeding events in arthroplasty patients.
- To identify patient or surgical factors predicting bleeding-related events.
Main Methods:
- Retrospective analysis of 116 patients receiving clopidogrel undergoing hip or knee arthroplasty (2007-2009).
- Data collected on clopidogrel timing, postoperative bleeding events, patient characteristics, and surgical factors.
- Level IV therapeutic study.
Main Results:
- Withholding clopidogrel 5+ days pre-operatively correlated with lower rates of surgical wound infection and antibiotic use.
- Postoperative outcomes were not affected by the timing of clopidogrel resumption.
- Advanced age, ASA score of 4, and revision surgery predicted increased adverse events (readmission, reoperation, antibiotic use, death).
Conclusions:
- A pre-operative clopidogrel hold of at least 5 days may decrease bleeding-related complications in arthroplasty.
- Immediate post-operative resumption of clopidogrel appears safe.
- High-risk patient factors (age, ASA score, revision surgery) warrant careful consideration.
Background:
Hip and knee arthroplasties are widely performed and vascular disease among patients having these procedures is common. Clopidogrel is a platelet inhibitor that decreases the likelihood of thrombosis. It may cause intraoperative and postoperative bleeding, but its discontinuation increases the risk of vascular events. There is currently no consensus regarding the best perioperative clopidogrel regimen that balances these concerns.
Questions/Purposes:
We determined (1) the relationship between time of perioperative clopidogrel administration and postoperative bleeding-related events after hip and knee arthroplasties and (2) patient characteristics or surgical factors that may predict these events.
Methods:
We retrospectively queried our inpatient pharmacy database for patients who received clopidogrel from 2007 to 2009 and identified 116 patients who underwent hip or knee arthroplasty. We recorded the time of perioperative clopidogrel administration, bleeding-related postoperative events, patient characteristics, and surgical factors.
Results:
Patients who withheld clopidogrel 5 or more days before hip or knee arthroplasty had lower rates of reoperation for infection and antibiotics prescribed for the surgical wound. Postoperative events did not vary with timing of clopidogrel resumption after surgery. Advanced age, an American Society of Anesthesiologists (ASA) score of 4, and revision surgery predicted increased readmission, reoperation for hematoma or infection, antibiotic use, and death.
Conclusions:
Holding clopidogrel for at least 5 days before hip or knee arthroplasty may lower the rate of bleeding-related events. We found no increase in events when patients resumed clopidogrel immediately after surgery. Advanced age, ASA score of 4, and revision surgery may be risk factors for bleeding-related events.
Level Of Evidence:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:29Venous Thrombosis III: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:22Aneurysm IV: Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview